Bacterial Pneumonia, HIV Therapy, and Disease Progression among HIV-Infected Women in the HIV Epidemiologic Research (HER) Study

Background. To determine the rate and predictors of community-acquired bacterial pneumonia and its effect on human immunodeficiency virus (HIV) disease progression in HIV-infected women, we performed a multiple-site, prospective study of HIV-infected women in 4 cities in the United States. Methods. During the period of 1993-2000, we observed 885 HIV-infected and 425 HIV-uninfected women with a history of injection drug use or high-risk sexual behavior. Participants underwent semiannual interviews, and CD4 + lymphocyte count and viral load were assessed in HIV-infected subjects. Data regarding episodes of bacterial pneumonia were ascertained from medical record reviews. Results. The rate of bacterial pneumonia among 885 HIV-infected women was 8.5 cases per 100 person-years, compared with 0.7 cases per 100 person-years in 425 HIV-uninfected women (P<.001). In analyses limited to follow-up after 1 January 1996, highly active antiretroviral therapy (HAART) and trimethoprim-sulfamethoxazole (TMP-SMX) use were associated with a decreased risk of bacterial pneumonia. Among women who had used TMP-SMX for 12 months, each month of HAART decreased bacterial pneumonia risk by 8% (adjusted hazard ratio [HR adj ], 0.92; 95% confidence interval [CI], 0.89-0.95). Increments of 50 CD4 + cells/mm 3 decreased the risk (HR adj , 0.88; 95% CI, 0.84-0.93), and smoking doubled the risk (HR adj , 2.12; 95% CI, 1.26-3.55). Bacterial pneumonia increased mortality risk (HR adj , 5.02; 95% CI, 2.12-11.87), with adjustment for CD4 + lymphocyte count and duration of HAART and TMP-SMX use. Conclusions. High rates of bacterial pneumonia persist among HIV-infected women. Although HAART and TMP-SMX treatment decreased the risk, bacterial pneumonia was associated with an accelerated progression to death. Interventions that improve HAART utilization and promote smoking cessation among HIV-infected women are warranted.