Pecego AC, Amâncio RT, Costa DM, et al. - Given the higher tendency of people living with HIV (PLWH) for severe respiratory infections, researchers sought to describe the etiology, clinical, and epidemiological characteristics of these infections using the severe acute respiratory infection (SARI) definition. In this prospective observational study, 49 PLWH hospitalized with fever and cough were included; median CD4 cell count: 80 cells/mm³, median time since HIV diagnosis and hospital admission: 84 months and 80% were antiretroviral therapy exposed. Classification of participants was done as follows: those with symptom onset up to 10 days formed severe acute respiratory infection group and 11–30 days as non-severe acute respiratory infection group. SARI was reported in 27 patients. The identification of etiology was done in 69%, of these, 47% were polymicrobial. They detected respiratory virus (9 SARI vs 13 non-SARI), bacteria (5 SARI vs 4 non-SARI), Mycobacterium tuberculosis (6 SARI group vs 7 non-SARI group), Pneumocystis jirovecii (4 SARI vs 1 non-SARI), Cryptococcus neoformans (1 SARI vs 3 non-SARI), and influenza A (1 SARI vs 2 non-SARI) among the participants. Despite a higher prevalence of dyspnea in SARI (78% vs 36%), the non-SARI exhibited the higher risk of death (4% vs 36%). Findings thereby suggest that severe acute respiratory infection can be caused by multiple pathogens and codetection is a common feature among the severely immunocompromised PLWH.