ACUTE PNEUMOCOCCAL PNEUMONIAE IN HIV-INFE CTED PATIENTS - CLINICAL-FEATURES AND EVOLUTION IN 27 PATIENTS

Objectives: Determine the clinical features and outcome of acute pneum onia due to Streptococcus pneumoniae in HIV infected patients compared with non-HIV infected patients. Methods: From January 1986 to Februar y 1992, we observed 33 episodes of pneumococcal pneumonia in 27 HIV-in fected patients. Most of the patients were drug addicts (16/27), and/o r originated from Central Africa or Haiti (10/27). In 9/27 (33%) patie nts, HIV infection was previously unknown. Eleven of the 27 patients w ere at the CDC stages II-III and CD4 cell count was greater than 200/m m(3) and CD8 cell count was greater than 1000/mm(3) in 12/23 patients and 10/20 patients respectively. Results: In 10/33 episodes, respirato ry symptoms were severe: bilateral pneumonia (n=2) and/or hypoxaemia ( n=9), In 22/33 episodes, hospitalization occurred less than 24 h after the onset of symptoms and in 9/33 episodes, the initial chest X-ray w as normal. Streptococcus pneumoniae was isolated in 16/33 episodes, fr om blood (n=10), bronchoalveolar lavage (n=3) or sputum (n=3). Penicil lin G or amoxicillin was used and allowed a favorable and quick respon se in all episodes, Recurrence occurred in 5/18 (27%) followed patient s, These recurrences were not favoured by a low CD4 cell count since i t was more than 200/mm(3) in these five patients. However, the mean co unt of CD8 cells was higher in patients with recurrence than in patien ts without recurrence, 1990/mm(3) versus 995/mm(3) (p=0.03). Conclusio n: CD8 hyperlymphocytosis could increase the risk of recurrence and wo uld help identify a subgroup with higher risk of pneumococcal pneumoni a among HIV infected persons.