COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS IN ADDIS-ABABA - ETIOLOGIC AGENTS AND THE IMPACT OF HIV-INFECTION

Setting: Black Lion Hospital, a tertiary care referral hospital in Addis Ababa, Ethiopia. Objective: To determine the prevalence of HIV infection in patients with Community Acquired Pneumonia (CAP) and compare the etiologic agents, clinical and radiographic presentation and outcome of the disease in HIV positive and negative patients. Design: A hospital based prospective study on 110 adult patients consecutively coming to Black Lion Hospital between August 1987 and July 1989. Results: 8 % of patients with pneumonia versus 2.4 % for the general population (P < 0.05) were seropositive for HIV-1. Streptococcus pneumoniae was the most common offending pathogen. HIV positive patients were more likely to be male, young and of urban residence. They had fewer chills, increased bilateral and multilobar lung involvement, frequent association with pulmonary tuberculosis and recurrent chest infiltrate. Conclusion: The incidence of Community Acquired Pneumonia in patients with HIV infection is likely to increase with the rapid rise in HIV infection. Future studies should therefore look further into (a) the pattern of etiologic agents, (b) unusual clinical patterns which may help set criteria for screening for HIV infection, and (c) the use of pneumococcal vaccine in selected groups of patients.