LEGIONNAIRES-DISEASE IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED PATIENTS - 8 CASES AND REVIEW

Despite being a well-known pathogen for immunocompromised patients, Le gionella pneumophila has infrequently been described in persons with i nfection due to human immunodeficiency virus (HIV). Since 1986, we hav e identified eight cases of legionella pneumonia among seven HIV-infec ted persons enrolled in the HIV Natural History Study of the U.S. Air Force. The median CD4(+) T cell count for these patients was 83/mm(3); 50% of the cases occurred in persons for whom AIDS was previously dia gnosed, and five of the cases were nosocomial. Six of the patients had coexistent pulmonary infections. None of the cases occurred among per sons receiving prophylactic therapy with trimethoprim-sulfamethoxazole . Therapeutically, all patients appeared to respond well to standard a ntilegionella therapy or high doses of trimethoprim-sulfamethoxazole. Overall, these seven patients represent 1.7% of the patients with late -stage HIV infection (Waiter Reed stage 5 or 6) in this cohort. L. pne umophila, although remaining an uncommon pathogen for HIV-infected pat ients, may produce serious disease in this population. HIV-infected pe rsons should be considered at risk for legionnaires' disease, particul arly in institutions where potable water supplies have become contamin ated.