Pathogen spectrum of community acquired pneumonia in people living with HIV (PLWH) in the German CAPNETZ-Cohort

• Published in: Infection Vol. 52; no. 1; pp. 129 - 137
• Main Authors: Schleenvoigt, Benjamin T., Ankert, Juliane, Barten-Neiner, Grit, Voit, Florian, Suttorp, Norbert, Boesecke, Christoph, Hoffmann, Christian, Stolz, Daiana, Pletz, Mathias W., Rohde, Gernot, Witzenrath, Martin, Panning, Marcus, Essig, Andreas, Rupp, Jan, Degen, Olaf, Stephan, Christoph
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-02-2024; Springer Nature B.V
• Subjects: Anti-Bacterial Agents - therapeutic use; Antiretroviral agents; Antiretroviral therapy; Blood culture; CD4 antigen; Community-Acquired Infections - drug therapy; Community-Acquired Infections - epidemiology; Family Medicine; General Practice; Haemophilus Infections - drug therapy; Haemophilus influenzae; HIV; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - epidemiology; Human immunodeficiency virus; Humans; Immunization; Infectious Diseases; Internal Medicine; Medicine; Medicine & Public Health; Pathogens; Pneumonia; Pneumonia, Bacterial - epidemiology; Prospective Studies; Public health; Respiratory tract; Streptococcus pneumoniae; Vaccination; Empirical antibiotic treatment; PLWH; Pneumonia; CAP; HIV; Community acquired pneumonia
• ISSN: 0300-8126; 1439-0973; 1439-0973
• DOI: 10.1007/s15010-023-02070-3

Objectives
The objective of this study was to identify the pathogen spectrum of community acquired pneumonia in people living with HIV (PLWH), and to compare it with a matched HIV negative group in order to reassess therapeutic strategies for PLWH.
Methods
Seventy-three (n = 73) PLWH (median CD4 3–6 months before CAP: 515/µl; SD 309) with community acquired pneumonia (CAP) were matched with 218 HIV-negative CAP controls in a prospective study design. Pathogen identifications used blood culture, samples from the upper and lower respiratory tract (culture and multiplex PCR) and urinary pneumococcal and legionella antigen test.
Results
Although the vaccination rate among PLWH with CAP was significantly higher (pneumococcal vaccination: 27.4 vs. 8.3%, p < 0.001; influenza vaccination: 34.2 vs. 17.4%, p = 0.009), pneumococci were found most frequently as pathogen among both PLWH (n = 19/21.3%) and controls (n = 34/17.2%; p = 0.410), followed by
Haemophilus influenzae
(PLWH, n = 12/13.5%, vs. controls, n = 25 / 12.6%; p = 0.850).
Staphylococcus aureus
was found equally in 20.2 and 19.2% in PLWH and controls, but infection or colonization could not be distinguished. Mortality during 6-month follow-up was significantly higher for PLWH (5/73, or 6.8%) versus controls (3/218, or 1.4%), however with lower case numbers than previously reported. Typical HIV-associated pathogens such as
Pneumocystis jirovecii
were found only exceptionally.
Conclusions
Our study underscores the persistent clinical burden of CAP for PLWH. From pathogen perspective, empirical antibiotic treatment for CAP in PLWH on antiretroviral therapy should cover pneumococci and
Haemophilus influenzae
and may be adopted from valid common recommendations
.