Living with HIV doesn't have to mean living with constant fear of infections. But here's the surprising truth: even with antiretroviral therapy (ART), people with HIV still face a higher risk of pneumonia and shingles. A groundbreaking longitudinal study spanning 2010 to 2023 has shed light on this often-overlooked aspect of HIV management, revealing crucial insights into infection risk patterns in the ART era.
This large-scale research tracked adults with HIV, meticulously documenting cases of community-acquired pneumonia and herpes zoster (shingles) across various CD4 counts, ages, and ART durations. The findings? CD4 count is a game-changer. Individuals with CD4 counts of 200 cells/µL or lower faced alarmingly high infection rates—up to 107 cases of pneumonia and 63 cases of shingles per 1,000 person-years, depending on age.
But here’s where it gets hopeful: long-term ART can dramatically reduce these risks. Those with CD4 counts of 500 cells/µL or higher, who had been on ART for at least a year, saw infection rates plummet to levels comparable to the general population—just 5–20 cases of pneumonia and 4–5 cases of shingles per 1,000 person-years. This underscores the life-changing power of sustained treatment and immune recovery.
And this is the part most people miss: these findings have significant implications for HIV vaccination strategies. If someone with HIV has achieved immune recovery through long-term ART, their vaccination needs might align closely with those of the general population. However, for individuals with incomplete immune recovery or ongoing virological failure, targeted vaccination strategies remain essential.
This study isn’t just about numbers—it’s a call to action. It highlights the critical importance of maintaining durable viral suppression and closely monitoring immune status in HIV management. By doing so, we can not only reduce infection risks but also tailor vaccination approaches to individual needs.
But here’s the controversial question: Should vaccination guidelines for people with HIV on long-term ART be standardized, or should they remain highly individualized? The study suggests alignment with the general population for those with immune recovery, but what about the gray areas? We’d love to hear your thoughts in the comments.
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.
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License: This article is available under the Creative Commons Attribution-Non Commercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/).
