NEJM articles that reported results from the START and TEMPRANO randomized clinical trials demonstrating the benefits of earlier antiretroviral therapy (ART). However, results of a new study from the nationwide Veterans Administration Cohort Study Virtual Cohort (JAIDS July 11, epub ahead of print) remind us of the ongoing importance of managing comorbidities in our HIV-infected patients. In an analysis of data from 41,933 HIV-infected veterans from the years 1996 to 2009, Attia and colleagues sought to estimate the contribution of any COPD diagnosis on community-acquired pneumonia requiring hospitalization. Pneumonia occurred at a rate of 53.9 per 1,000 person-years among veterans with HIV and COPD and at a rate of 19.4 per 1,000 person-years among HIV-infected veterans with no COPD. In an analysis of pneumonia risk adjusted for viral load >500 copies/mL, CD4 count <200 cells/mm³, age, smoking, renal disease, liver disease, and other factors, the incidence risk ratio for COPD was 1.9 (95% confidence interval 1.64-2.30), similar to the 1.76 for CD4 count <200 cells/mm³ and 1.83 for renal insufficiency. This study had several important limitations, including use of clinic or inpatient diagnosis coding to define COPD, use of hospital discharge diagnosis coding for pneumonia diagnosis, and viral load suppression defined as <500 copies/mL. Nonetheless, the findings suggest that COPD is an important risk for pulmonary infections in the era of ART and that appropriate COPD management may avert hospitalizations for some HIV-infected patients.  (Read abstract on PubMed.)