Quitting Smoking Cuts Risk of Bacterial Pneumonia in People With HIV

Quitting Smoking Cuts Risk of Bacterial Pneumonia in People With HIV

Quitting Smoking Cuts Risk of Bacterial Pneumonia in People With HIV

Quitting Smoking Cuts Risk of Bacterial Pneumonia in People With HIVBacterial pneumonia is the general term for lung inflammation caused by the infectious presence of various species of bacteria. This form of pneumonia, which frequently appears in adults, tends to have a greater negative health impact than pneumonia that comes from viral or fungal microorganisms. People infected with human immunodeficiency virus (HIV) have significantly increased risks for developing bacterial pneumonia; in HIV-positive people who smoke, risks for the disease rise much higher. At its worst, bacterial pneumonia in HIV-positive individuals can herald the onset of acquired immune deficiency syndrome, or AIDS.

Bacterial Pneumonia Basics

Like pneumonia caused by viruses or fungi, bacterial pneumonia typically occurs when bacteria already living in the mouth, sinuses, or nose migrate to the lungs, or when an affected individual breathes in bacteria not normally found living in or on the body. According to the U.S. National Library of Medicine, the single most likely source of the disorder is a species called Streptococcus pneumoniae. Other common sources of bacterial pneumonia include Mycoplasma pneumoniae, Haemophilus influenzae and Chlamydia trachomatis.

In people with relatively healthy immune systems, common symptoms of bacterial pneumonia (and other forms of pneumonia) include chills, tremors, shortness of breath, a moderate to high fever, headaches, coughing that may or may not produce discolored or bloody mucus, fatigue, appetite loss, skin clamminess and high sweat production. People with damaged immune systems (and certain other population groups) have increased risks for developing severe complications of pneumonia that may include potentially fatal changes in normal lung function, the formation of pus-filled pockets called abscesses in lung tissue, and a condition called pleural effusion, which involves the abnormal accumulation of fluid inside a membrane that covers the lungs’ exterior.

Effects of HIV Infection

Roughly one to five out of every 100 HIV-positive people develop bacterial pneumonia while receiving a modern form of HIV treatment called antiretroviral therapy (ART), according to a study published in 2011 in the journal Proceedings of the American Thoracic Society. Without ART, five to 20 out of every 100 HIV-positive people develop the disorder. HIV causes its lung-related effects by attacking and infecting immune system cells called CD4 T-cells—which circulate throughout the body—as well as immune system cells called alveolar macrophages, which are located in the outer regions of the lungs in the vicinity of tiny sac-like structures called alveoli. When bacteria or other infectious microorganisms that cause pneumonia establish themselves in the lungs, they sharply increase HIV’s ability to reproduce inside the immune system components that gather to fight these microorganisms, including CD4 T-cells and alveolar macrophages. In turn, increased HIV reproduction worsens the virus’s health impact.

 Effects of Smoking

Smoking increases the rate of bacterial pneumonia by 70 to 100 percent in people infected with HIV, the authors of a study published in 2013 in the journal BMC Medicine report. This rate of increase occurs in people who receive antiretroviral therapy, as well as in people who don’t receive ART. In real-world terms, this means that as many as two to 10 out of every 100 HIV-positive smokers receiving ART will develop bacterial pneumonia, while as many as 10 to 40 out of every 100 HIV-positive smokers not receiving ART will develop the disease. When people infected with HIV stop smoking, their risks for bacterial pneumonia don’t return to the levels found in HIV-positive people who have never smoked; however, they do drop by roughly 33 percent.


HIV-positive people who develop recurring pneumonia (whether from bacteria or any other source) may eventually receive a diagnosis for the extensive immune system collapse associated with AIDS, according to guidelines established by the Centers for Disease Control and Prevention. Apart from bacterial infection, people with immune systems compromised by HIV sometimes develop pneumonia as a consequence of exposure to a fungal species called Pneumocystis carinii (or Pneumocystis jiroveci). The presence of this type of pneumonia is a defining characteristic for the presence of AIDS, even if it only occurs once. Out of all of the opportunistic infections associated with HIV and AIDS, Pneumocystis carinii pneumonia produces the highest rate of fatality, the U.S. Department of Health and Human Services’ AIDS.gov reports. Doctors can potentially prevent Pneumocystis-related pneumonia by pre-treating their patients with certain antibiotics; antibiotic treatment can also help control the severity of an existing case of Pneumocystis pneumonia.

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