Pneumonia in HIV-infected persons - Increased risk with cigarette smoking and treatment interruption

被引:83
作者
Gordin, Fred M. [1 ,2 ]
Roediger, Mollie P. [3 ]
Girard, Pierre-Marie [4 ,5 ]
Lundgren, Jens D. [6 ]
Miro, Jose M. [7 ]
Palfreeman, Adrian [8 ,9 ]
Rodriguez-Barradas, Maria C. [10 ,11 ]
Wolff, Marcelo J. [12 ,13 ]
Easterbrook, Philippa J. [14 ]
Clezy, Kate [15 ]
Slater, Leonard N. [16 ,17 ]
机构
[1] Vet Affairs Med Ctr, Washington, DC 20422 USA
[2] George Washington Univ, Washington, DC USA
[3] Univ Minnesota, Sch Publ Hlth, Div Biostat, Minneapolis, MN 55455 USA
[4] Univ Paris 06, Hop St Antoine, Serv Malad Infect & Trop, Paris, France
[5] Inst Med & Epidemiol Appl, Paris, France
[6] Univ Copenhagen, Copenhagen HIV Programme, Copenhagen, Denmark
[7] Univ Barcelona, Hosp Clin, Inst Invest Biomed August Pi Sunyer, Barcelona, Spain
[8] Univ Hosp, Leicester, Leics, England
[9] MRC, London, England
[10] Michael E DeBakey Vet Affairs Med Ctr, Houston, TX USA
[11] Baylor Coll Med, Houston, TX 77030 USA
[12] Univ Chile, Sch Med, Santiago, Chile
[13] Arriaran Fdn, Santiago, Chile
[14] Kings Coll London, Dept HIV & Genitourinary Med, London WC2R 2LS, England
[15] Univ New S Wales, Sydney, NSW, Australia
[16] Univ Oklahoma, Coll Med, Oklahoma City, OK 73190 USA
[17] Vet Affairs Med Ctr, Oklahoma City, OK 73104 USA
基金
英国医学研究理事会;
关键词
pneumonia; smoking; HIV; bacterial infections;
D O I
10.1164/rccm.200804-617OC
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Rationale: Bacterial pneumonia is a major cause of morbidity for HIV-infected persons and contributes to excess mortality in this population. Objectives: To evaluate the frequency and risk factors for occurrence of bacterial pneumonia in the present era of potent antiretroviral therapy. Methods: We evaluated data from a randomized trial of episodic antiretroviral therapy. The study, Strategies for Management of Antiretroviral Therapy, enrolled 5,472 participants at 318 sites in 33 countries. Study patients had more than 350 CD4 cells at baseline. Diagnosis of bacterial pneumonia was confirmed by a blinded clinical-events committee. Measurements and Main Results: During a mean follow-up of 16 months, 116 participants (2.2%) developed at least one episode of bacterial pneumonia. Patients randomized to receive episodic antiretroviral therapy were significantly more likely to develop pneumonia than patients randomized to receive continuous antiretroviral therapy (hazard ratio, 1.55; 95% confidence interval, 1.07-2.25; P = 0.02). Cigarette smoking was a major risk factor: Current-smokers had more than an 80% higher risk of pneumonia compared with never-smokers (hazard ratio, 1.82; 95% confidence interval, 1.09-3.04; P = 0.02). Participants who were on continuous HIV treatment and were current smokers were three times more likely to develop bacterial pneumonia than nonsmokers. Current smoking status was significant, but a past history of smoking was not. Conclusions: Bacterial pneumonia is a major source of morbidity, even for persons on potent antiretroviral therapy, including those with high CD4 cells. Efforts to reduce this illness should stress the importance of uninterrupted antiretroviral therapy and attainment and/or maintenance of nonsmoking status.
引用
收藏
页码:630 / 636
页数:7
相关论文
共 28 条
  • [1] Primary care guidelines for the management of persons infected with human immunodeficiency virus: Recommendations of the HIV Medicine Association of the Infectious Diseases Society of America
    Aberg, JA
    Gallant, JE
    Anderson, J
    Oleske, JM
    Libman, H
    Currier, JS
    Stone, VE
    Kaplan, JE
    [J]. CLINICAL INFECTIOUS DISEASES, 2004, 39 (05) : 609 - 629
  • [2] Cigarette smoking and infection
    Arcavi, L
    Benowitz, NL
    [J]. ARCHIVES OF INTERNAL MEDICINE, 2004, 164 (20) : 2206 - 2216
  • [3] Invasive pneumococcal disease in a cohort of HIV-infected adults: incidence and risk factors, 1990-2003
    Barry, PM
    Zetola, N
    Keruly, JC
    Moore, RD
    Gebo, KA
    Lucas, GM
    [J]. AIDS, 2006, 20 (03) : 437 - 444
  • [4] Benito N, 2001, J ACQ IMMUN DEF SYND, V27, P35, DOI 10.1097/00126334-200105010-00006
  • [5] Community-acquired pneumonia in a cohort of former injection drug users with and without human immunodeficiency virus infection: Incidence, etiologies, and clinical aspects
    Boschini, A
    Smacchia, C
    DiFine, M
    Schiesari, A
    Ballarini, P
    Arletti, M
    Gabrielli, C
    Castellani, G
    Geneva, R
    Pantani, P
    Lepri, AC
    Rezza, G
    [J]. CLINICAL INFECTIOUS DISEASES, 1996, 23 (01) : 107 - 113
  • [6] Evaluation of effectiveness of the 23-valent pneumococcal capsular polysaccharide vaccine for HIV-infected patients
    Breiman, RF
    Keller, DW
    Phelan, MA
    Sniadack, DH
    Stephens, DS
    Rimland, D
    Farley, MM
    Schuchat, A
    Reingold, AL
    [J]. ARCHIVES OF INTERNAL MEDICINE, 2000, 160 (17) : 2633 - 2638
  • [7] Cigarette smoking, bacterial pneumonia, and other clinical outcomes in HIV-1 infection
    Burns, DN
    Hillman, D
    Neaton, JD
    Sherer, R
    Mitchell, T
    Capps, L
    Vallier, WG
    Thurnherr, MD
    Gordin, FM
    Johns, S
    Ellison, J
    Hickson, MJ
    Lee, J
    Thompson, M
    Creagh, T
    Morris, A
    Ernst, J
    POllard, C
    Anastos, K
    Bar, M
    Doramajian, E
    Blatt, D
    Moore, D
    Renzetti, R
    Verheggen, R
    LuskinHawk, R
    Torres, RA
    Townley, D
    Clanon, K
    Morris, B
    Owen, W
    Brosgart, C
    Crane, LR
    Ebright, J
    Schuman, P
    Vallier, W
    Fairclough, C
    Holloway, WJ
    Winslow, D
    Szabo, S
    Bincsik, A
    Swanson, K
    Cohn, DL
    Reves, RR
    Grodesky, MJ
    Mesard, CA
    Gans, JE
    ElSadr, W
    Capps, L
    Guity, C
    [J]. JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES AND HUMAN RETROVIROLOGY, 1996, 13 (04): : 374 - 383
  • [8] *CDC, 1992, MMWR-MORBID MORTAL W, P41
  • [9] Community-acquired bacterial pneumonia in human immunodeficiency virus-infected patients -: Validation of severity criteria
    Cordero, E
    Pachón, J
    Rivero, A
    Girón, JA
    Gómez-Mateos, J
    Merino, MD
    Torres-Tortosa, M
    González-Serrano, M
    Aliaga, L
    Collado, A
    Hernández-Quero, J
    Barrera, A
    Nuño, E
    [J]. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2000, 162 (06) : 2063 - 2068
  • [10] The impact of cigarette smoking on mortality, quality of life, and comorbid illness among HIV-positive veterans
    Crothers, K
    Griffith, TA
    McGinnis, KA
    Rodriguez-Barradas, MC
    Leaf, DA
    Weissman, S
    Gibert, CL
    Butt, AA
    Justice, AC
    [J]. JOURNAL OF GENERAL INTERNAL MEDICINE, 2005, 20 (12) : 1142 - 1145