Impact of bacterial pneumonia and Pneumocystis carinii pneumonia on human immunodeficiency virus disease progression

The course of pneumonia caused by pyogenic bacteria and Pneumocystis carini i was examined in a multicity cohort study of HIV infection. The median dur ation of survival among 150 individuals following initial bacterial pneumon ia was 24 months, compared with 37 months among 299 human immunodeficiency virus (HIV)-infected control subjects matched by study site and CD4 lymphoc yte count (P < .001). For 152 subjects with P, carinii pneumonia, median su rvival was 23 months, compared with 30 months for 280 matched control subje cts (P = .002). Median durations of survival associated with the two types of pneumonia differed by only 47 days, despite a higher median CD4 lymphocy te count associated with bacterial pneumonia, These results suggest that bo th P, carinii pneumonia and bacterial pneumonia are associated with a signi ficantly worse subsequent HIV disease course. The similarity of prognosis a fter one episode of bacterial pneumonia vs. an AIDS-defining opportunistic infection and the proportion of cases occurring in association with a CD4 l ymphocyte count of >200 suggest that measures to prevent bacterial pneumoni a should be emphasized.