Pneumonias

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.

Symptoms

• 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.

Diagnosis

• 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.

Treatment

• 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 3 to 6 months. This is called "secondary prophylaxis."

Prevention

• 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 3 to 6 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).

Symptoms

• 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

Treatment

• Bacterial pneumonias are almost always treatable with antibiotics

Prevention

• Pneumovax vaccine is recommended for all HIV+ people to reduce the risk of developing pneumococcal pneumonia. The vaccine may be repeated in 5 to 7 years.