background: bacterial pneumonia is one of the main causes of morbidity and mortality in patients infected by the human immunodeficiency virus (hiv). the main objective of this study was to evaluate the effect of macrolide therapy in combination with a beta-lactam based empiric regimen for inpatients with community-acquired pneumonia and hiv. methods: this is a retrospective cohort study of hospitalized patients. adult patients who had received treatment with ceftriaxone or ceftriaxone plus clarithromycin were included. results: 76 patients met the inclusion criteria. among baseline characteristics analyzed, only respiratory rate showed significant difference: patients who had received clarithromycin were more likely to have a respiratory rate > 30/min than patients who received only ceftriaxone (64% versus 36%, p = 0.03). icu admission was the only outcome that showed a significant difference, more frequent in the ceftriaxone plus clarithromycin group (45% versus 20%, p = 0.03). conclusions: this study does not support the addition of a macrolide to a beta-lactam based regimen in hiv-infected patients. this is probably related to the patients' immunodeficiency status, which impairs the immunomodulatory properties of the macrolides.