28; 95% CI 0.96–1.69; P=0.09 for each additional cycle received), which was independent of proximal CD4 cell count. During a median follow-up of 7 years, 4.4% of ESPRIT participants experienced bacterial pneumonia. Single-episode bacterial pneumonia was the most commonly

reported infection in ESPRIT. These data indicate that bacterial pneumonia still contributes substantially to morbidity in the era of potent cART and in a group of patients with relatively high CD4 buy Tacrolimus cell counts. As expected, the greatest risk for bacterial pneumonia occurred in those with very low CD4 counts, with lower risks in those with CD4 counts ≥350 cells/μL compared with those with CD4 counts <350 cells/μL. Recurrent bacterial pneumonia (two or more episodes in a 12-month period)

during follow-up was rare. As bacterial pneumonia events seem to be related in part to more recent IL-2, it is possible that the lack of further receipt of rIL-2 in just under half of the IL-2 arm experiencing a pneumonia event is part of the explanation for our not seeing click here higher rates of recurrent bacterial pneumonia. It is likely that these figures are an underestimate of the risk of bacterial pneumonia, as we only included events meeting the criteria for a probable or confirmed pneumonia event. Traditional risk factors for bacterial pneumonia in HIV-1-infected patients were identified in the ESPRIT cohort, including older age, IDU, prior recurrent bacterial pneumonia as an ADI, lower CD4 cell count and detectable HIV viraemia

(defined as ≥500 copies/mL). These data are consistent with the findings of the SMART study on bacterial pneumonia [12], where detectable viraemia (>400 vs. <400 copies/mL) in patients on continuous cART even when the CD4 count was >500 cells/μL Aldol condensation was associated with an increased hazard for bacterial pneumonia (overall HR 2.65; 95% CI 1.49–4.72; P=0.001), and treatment interruption (associated with viral rebound and CD4 cell count decline) compared with continuous cART was also associated with an increased hazard (HR 1.55; 95% CI 1.07–2.25; P=0.02) for bacterial pneumonia. However, in the SMART study the strongest predictors of bacterial pneumonia in both study arms were prior history of recurrent bacterial pneumonia and current cigarette smoking. For patients on continuous cART, the risk of bacterial pneumonia was 3-fold higher in current smokers than in life-long nonsmokers. A limitation of this analysis is the lack of smoking data. It is noteworthy that the majority of pneumonia events did not have a microbiological diagnosis and this is in keeping with other studies [12] and indeed with clinical practice, where in both, the microbiological yield is low, either because the appropriate cultures were not taken or cultures were negative. As a consequence, we were not able to use these data as a surrogate for pneumococcal vaccination, pneumococcal vaccination data were not collected in ESPRIT.