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Pneumonias and HIV

July 3, 2014

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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 HIV+ people 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 HIV+ people since the beginning of the AIDS epidemic. While PCP used to be fatal for many HIV+ people, it is now preventable and treatable. Drugs to prevent PCP are recommended for all HIV+ people 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
  • Weight loss

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


  • Sputum 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, but many are allergic to the sulfa contained in the drug (desensitization may be used to overcome allergic reactions)
  • 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 allergic to sulfa, there are alternative drugs for prophylaxis
  • May discontinue prophylaxis when 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 HIV+ people with weakened immune systems, especially HIV+ women, 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


  • The Pneumovax 23 vaccine (made by Merck) is recommended for all HIV+ people 19 years of age or older to reduce the risk of developing pneumococcal pneumonia. The vaccine may be repeated in five to seven years.
  • In 2012, the CDC recommended that all HIV+ people 19 years of age or older also receive the Prevnar13 vaccine (made by Pfizer)
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Related Stories

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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