Balakrishna S, Wolfensberger A, Kachalov V, et al. - According to findings, a substantial decline in bacterial pneumonia incidence in people with HIV (PWH) could have been mediated by the improvements in cascade of care of HIV as well as reduction in smoking.

• This study involved 12,927 PWH with follow-ups between 2008 and 2018, to determine risk-factors for bacterial pneumonia as well as the link between risk-factors and changes in bacterial pneumonia incidence in this population.

• A follow-up of 100,779 person-years(py) revealed occurrence of 985 bacterial pneumonia events, and a significant decline in bacterial pneumonia incidence was noted from 13.2 cases/1,000 py in 2008 to 6.8 cases/1,000 py in 2018.

• Factors significantly linked with higher bacterial pneumonia incidence were: older age, lower education-level, intravenous drug use, smoking, lower CD4-cell-count, higher HIV-viral load, and prior pneumonia events.

• A significant association of CD4-cell-counts 350-499 with an elevated risk, vs CD4≥500, was also revealed (adjusted HR,1.39; 95% CI,1.01-1.89).

• Over the last decade, there has been a reducing incidence which can be explained by the decreasing proportion of cases with CD4<500, viral-RNA>200, and smoking>one cigarette/day.