HIV and Pneumococcal Disease

Although we automatically think about opportunistic and atypical infections in immunocompromised patients, it is important to note that , similar to non-HIV infected patients, Streptococcus pneumoniae, is the most common bacterial pathogens of CAP in patients with HIV.

As was discussed this morning, HIV infection substantially increases the risk of invasive pneumococcal infection, particularly among those patients with a low CD4 count <200, and those not on therapy. This increased risk may be partially explained by the observation that HIV infected individuals have a predisposition for pneumococcal nasopharyngeal colonization.

For this reason, the Centers for Disease Control and Prevention (CDC) recommends that all HIV–infected patients be vaccinated (preferably early in the disease while they still have the ability to mount an effective antibody response).

Here is a review on the topic.

Invasive pneumococcal disease in patients infected with HIV: still a threat in the era of highly active antiretroviral therapy. Jordano et al. Clin Infect Dis.38(11):1623.

* Chest radiograph of an HIV positive individual with a CD4 cell count above 200 cells/mm3, revealing right upper lobe consolidation. Sputum and blood cultures were positive for Streptococcus pneumoniae.