Global strategies to prevent bacterial pneumonia in adults with HIV disease

Daniel Feikin, Charles Feldman, Anne Schuchat, Edward N. Janoff

Research output: Contribution to journalReview article

Abstract

We examined the peer-reviewed literature on the burden of bacterial pneumonia and the effectiveness of interventions for its prevention among HIV-infected adults in developed and developing countries. Bacterial pneumonia rates were up to 25-fold higher among HIV-infected adults than in the general community, with rates increasing as CD4+ T-cell count decreases. In developed countries, cohort studies showed that highly active antiretroviral therapy (HAART) had the most consistent effect on reducing pneumonia. In a prospective cohort and case-control studies from these regions, pneumococcal polysaccharide vaccine reduced pneumococcal disease in certain subgroups, particularly those with higher CD4+ T cells/μL. In patients with fewer than 200 CD4+ T cells/μL, antimicrobial prophylaxis was usually effective in reducing pneumonia. In sub-Saharan Africa, randomised controlled trials concluded that co-trimoxazole prophylaxis decreased rates of bacterial pneumonia, but pneumococcal polysaccharide vaccine prevented neither pneumonia nor invasive pneumococcal disease. Although not yet fully evaluated in Africa, based on experience in industrialised nations, use of HAART in Africa may have substantial potential to prevent bacterial pneumonia.

Original languageEnglish (US)
Pages (from-to)445-455
Number of pages11
JournalLancet Infectious Diseases
Volume4
Issue number7
DOIs
StatePublished - Jul 1 2004
Externally publishedYes

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Bacterial Pneumonia
Developed Countries
HIV
Pneumonia
Pneumococcal Vaccines
Highly Active Antiretroviral Therapy
T-Lymphocytes
Africa South of the Sahara
Sulfamethoxazole Drug Combination Trimethoprim
CD4 Lymphocyte Count
Developing Countries
Case-Control Studies
Cohort Studies
Randomized Controlled Trials

ASJC Scopus subject areas

  • Infectious Diseases

Cite this

Global strategies to prevent bacterial pneumonia in adults with HIV disease. / Feikin, Daniel; Feldman, Charles; Schuchat, Anne; Janoff, Edward N.

In: Lancet Infectious Diseases, Vol. 4, No. 7, 01.07.2004, p. 445-455.

Research output: Contribution to journalReview article

Feikin, Daniel ; Feldman, Charles ; Schuchat, Anne ; Janoff, Edward N. / Global strategies to prevent bacterial pneumonia in adults with HIV disease. In: Lancet Infectious Diseases. 2004 ; Vol. 4, No. 7. pp. 445-455.
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