[Pneumonia in patients with HIV infection].

Pneumonia is the leading HIV-associated infection. It may occur at an early stage of HIV-infection. The spectrum of microorganisms includes bacteria, mainly Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae and Mycobacterium tuberculosis. In addition, fungi such as Pneumocystis carinii, Cryptococcus neoformans and Histoplasma capsulatum are common HIV-associated pathogens. The diagnostic work-up depends on the epidemiology (travel history) and the immune status (CD4-lymphocytes). Imaging techniques are always required, and the microbiological analysis of expectorations should be performed. In patients with < 200/microliter CD4-lymphocytes, a bronchoalveolar lavage is generally required. If tuberculosis is suspected, a CT-scan and a transbronchial biopsy should be performed, irrespective of the CD4-lymphocyte counts. During treatment of Pneumocystis-carinii-pneumonia, the possibility of sulpha resistance (i.e. mutations in dihydropteroate synthase) should be considered. The primary and secondary prophylaxis against opportunistic pathogens can be discontinued in patients with effective antiretroviral therapy, as soon as CD4-lymphocytes persistently (> 3 months) remain above threshold levels.