Opportunistic bacterial and fungal infections of the lower respiratory tract, most
commonly those caused by Streptococcus pneumoniae (the pneumococcus),
Mycobacterium tuberculosis, and Pneumocystis jirovecii, remain the major causes of
mortality in those infected with human immunodeficiency virus (HIV). Bacterial
respiratory pathogens most prevalent in those infected with HIV, other than M.
tuberculosis, represent the primary focus of the current review with particular
emphasis on the pneumococcus, the leading cause of mortality due to HIV infection
in the developed world. Additional themes include: i) risk factors; ii) the predisposing
effects of HIV-mediated suppression on pulmonary host defenses, possibly intensified by smoking; iii) clinical and laboratory diagnosis, encompassing
assessment of disease severity and outcome; and iv) antibiotic therapy. The final
section addresses current recommendations with respect to pneumococcal
immunization in the context of HIV infection, including an overview of the rationale
underpinning the current “prime-boost” immunization strategy based on sequential
administration of pneumococcal conjugate vaccine 13 (PCV13) and pneumococcal
conjugate vaccine 23 (PPV23).