Infection Risk Patterns in the ART Era
People with HIV on antiretroviral therapy (ART) still face elevated risks of community-acquired pneumonia and herpes zoster, particularly when immune recovery remains incomplete, according to a large longitudinal cohort study.
The analysis followed adults with HIV in care between 2010 and 2023, documenting rates of community-acquired pneumonia and herpes zoster across varying CD4 counts, ages, and durations of ART. Infection incidence was measured per 1000 person-years of follow-up to capture population-level trends over time.
CD4 Count Strongly Influences Community-Acquired Pneumonia and Herpes Zoster Incidence
The study found that individuals with CD4 counts of 200 cells/µL or lower experienced the highest infection rates, ranging from 34–107 per 1,000 person-years for community-acquired pneumonia and 9–63 per 1,000 for herpes zoster, depending on age.
By contrast, people with HIV who had CD4 counts of 500 cells/µL or higher and were on ART for at least one year showed far lower incidence rates—5–20 per 1,000 person-years for pneumonia and 4–5 for herpes zoster. These figures align closely with those seen in the general population, underscoring the protective effects of sustained ART and immune reconstitution.
Implications for HIV Vaccination Strategies
The findings suggest that vaccine guidance for people with HIV who have achieved immune recovery through long-term ART may be aligned with that of the general population. However, targeted vaccination strategies remain warranted for individuals with ongoing virological failure or incomplete immune recovery.
This study highlights the importance of maintaining durable viral suppression and monitoring immune status in HIV management, both to reduce infection risk and to inform individualized vaccination approaches.
Reference: Te Linde E et al. Incidence of community-acquired pneumonia and herpes zoster in people with HIV based on CD4-count and age in the current antiretroviral therapy era: a longitudinal cohort study. Clin Infect Dis. 2025;ciaf686.
