RSS Feeds
Pneumococcal Disease and HIV Infection
- P. Klenerman, MD;
- G. A. Luzzi, MD; and
- T. E. A. Peto, MD
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TO THE EDITOR:
Janoff and colleagues [1] note that natural resistance to invasive Streptococcus pneumoniae infection may involve humoral factors such as C-reactive protein (CRP). We have investigated serum CRP levels in patients with human immunodeficiency virus (HIV) infection and the acquired immunodeficiency syndrome (AIDS) who presented with pneumococcal pneumonia.
Serum CRP was measured in 21 patients who were hospitalized with fever and respiratory symptoms and signs and in whom S. pneumoniae was isolated from blood or sputum culture. Seven were HIV-1 antibody positive; five fulfilled the Centers for Disease Control criteria for the diagnosis of AIDS, and one had asymptomatic HIV infection. One other patient had two episodes of pneumococcal pneumonia, separated by 18 months and the development of AIDS; CRP was 38.7 mg/dL during the first episode and 2 mg/dL during the second.
The results Figure 1 indicate a significant reduction in the CRP response to pneumococcal infection in patients with AIDS compared with patients who were at low risk for HIV infection or those with early HIV disease (P < 0.001), a highly significant difference despite relatively small sample sizes.
![Figure 1. 7 mg/dL] at presentation in three groups of patients with pneumococcal pneumonia. The three groups included 1) patients at low risk for infection with the human immunodeficiency virus [HIV]; 2) those with asymptomatic HIV infection; and 3) those with the acquired immunodeficiency syndrome (AIDS).](393.2/F1.small.gif)
The mechanism whereby the CRP response becomes deficient in AIDS is unknown but may involve defective cytokine secretion by monocytes or abnormal hepatic synthesis [2]. Other acute-phase reactions, including fever, may remain intact. The loss of the CRP response may contribute to the increased susceptibility to S. pneumoniae infection in HIV: animal models have shown that CRP has a protective effect against pneumococci in a similar manner to that of antibody [3, 4]. Investigations of the possible impairment of CRP response to infections by other bacteria, such as Haemophilus influenzae, which also occur with increased frequency in patients with HIV, are warranted.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
