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Pneumonias and HIV

October 26, 2015

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Pneumocystis (jiroveci) Pneumonia (PCP)

PCP is caused by a fungus called Pneumocystis jiroveci. A healthy immune system can control the fungus. However, in people living with HIV with CD4 cell counts below 200, Pneumocystis can be a problem.

PCP has been the most common opportunistic infection and the most common pneumonia in people living with HIV since the beginning of the AIDS epidemic. While PCP used to be deadly for many people living with HIV, it is now preventable and treatable. Drugs to prevent PCP are recommended for all people living with HIV with CD4 cell counts below 200. Taking drugs to prevent disease is called "prophylaxis".


  • Fever
  • Shortness of breath or difficulty breathing, especially with activity
  • Dry, non-productive cough (no mucus or phlegm)
  • Weight loss

Anyone with these symptoms should see a health care provider immediately.


  • Sputum, or mucus sample taken for special stain for PCP
  • Chest x-ray may have a characteristic appearance
  • Because the chest x-ray may also appear normal in someone with PCP, diagnosis is usually based on a combination of factors, including symptoms, physical exam, sputum sample, chest x-ray, amount of oxygen in the blood, and other blood tests.


  • Antibiotics:

    • First choice treatment is Bactrim or Septra for those not allergic to the sulfa contained in the drug
    • If you are allergic to sulfa, there are other antibiotics available to treat PCP
  • Prednisone (a steroid) can be used to reduce inflammation
  • Usually treated for three weeks
  • To avoid getting PCP again after the infection has been treated, a person stays on a lower dose of antibiotics until her or his CD4 count is above 200 for at least three to six months. This is called "secondary prophylaxis."


  • People with fewer than 200 CD4 cells take oral Bactrim or Septra
  • If you are allergic to sulfa, there are alternative drugs for prophylaxis
  • You may discontinue prophylaxis when your CD4 cell count rises above 200 for at least three to six months

Bacterial Pneumonias

Bacteria that cause pneumonia are commonly found in the nose and throat. In people living with HIV who have weakened immune systems, especially women living with HIV, the bacteria can multiply and work their way into the lungs, causing pneumonia. The most common bacteria to cause pneumonia in the US are Streptococcus pneumoniae (pneumococcus).


  • Onset usually quick (within days)
  • Fever
  • Sweating
  • Shaking/chills
  • Cough that produces rust colored or greenish mucus
  • Increased breathing and pulse rate
  • Bluish colored lips or nails


  • Bacterial pneumonias are almost always treatable with antibiotics


  • There are two vaccines to prevent pneumococcal pneumonia: PPSV23 (Pneumovax) and PCV 13 (Prevnar 13). Both are recommended for all people living with HIV 19 years of age or older to reduce the risk of developing pneumococcal pneumonia
  • The Pneumovax vaccine is given initially and repeated at age 65. It is no longer recommended to receive this vaccine every five years.
  • The Prevnar 13 vaccine is only given once
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How to Prevent PCP
More on Pneumocystis Pneumonia (PCP)

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This article was provided by The Well Project. Visit The Well Project's Web site to learn more about their resources and initiatives for women living with HIV. The Well Project shares its content with to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from or the advertisers on this site. No advertiser on this site has any editorial input into The Well Project's content.

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