Decreasing Incidence and Determinants of Bacterial Pneumonia in People With HIV: The Swiss HIV Cohort Study
Author:
Balakrishna Suraj12, Wolfensberger Aline1, Kachalov Viacheslav12, Roth Jan A345, Kusejko Katharina12, Scherrer Alexandra U12, Furrer Hansjakob6, Hauser Christoph6, Calmy Alexandra7, Cavassini Matthias8ORCID, Schmid Patrick9, Bernasconi Enos10, Battegay Manuel3, Günthard Huldrych F12, Kouyos Roger D12, Anagnostopoulos A, Battegay M, Bernasconi E, Böni J, Braun D L, Bucher H C, Calmy A, Cavassini M, Ciuffi A, Dollenmaier G, Egger M, Elzi L, Fehr J, Fellay J, Furrer H, Fux C A, Günthard H, Haerry D, Hasse B, Hirsch H H, Hoffmann M, Hösli I, Huber M, Kahlert C R, Kaiser L, Keiser O, Klimkait T, Kouyos R D, Kovari H, Ledergerber B, Martinetti G, de Tejada B Martinez, Marzolini C, Metzner K J, Müller N, Nicca D, Paioni P, Pantaleo G, Perreau M, Rauch A, Rudin C, Scherrer A U, Schmid P, Speck R, Stöckle M, Tarr P, Trkola A, Vernazza P, Wandeler G, Weber R, Yerly S,
Affiliation:
1. Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland 2. Institute of Medical Virology, University of Zurich, Zurich, Switzerland 3. Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland 4. Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, Basel, Switzerland 5. Division of Research and Analytical Services, Department of Informatics, University Hospital Basel, Basel, Switzerland 6. Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland 7. Division of Infectious Diseases, University Hospital Geneva, University of Geneva, Geneva, Switzerland 8. Division of Infectious Diseases, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland 9. Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland 10. Division of Infectious Diseases, Regional Hospital Lugano, Lugano, Switzerland
Abstract
Abstract
Background
Bacterial pneumonia is a leading reason for hospitalization among people with HIV (PWH); however, evidence regarding its drivers in the era of potent antiretroviral therapy is limited.
Methods
We assessed risk factors for bacterial pneumonia in the Swiss HIV Cohort Study using marginal models. We further assessed the relationship between risk factors and changes in bacterial pneumonia incidence using mediation analysis.
Results
We included 12927 PWH with follow-ups between 2008 and 2018. These patients had 985 bacterial pneumonia events during a follow-up of 100779 person-years. Bacterial pneumonia incidence significantly decreased from 13.2 cases/1000 person-years in 2008 to 6.8 cases/1000 person-years in 2018. Older age, lower education level, intravenous drug use, smoking, lower CD4-cell count, higher HIV load, and prior pneumonia were significantly associated with higher bacterial pneumonia incidence. Notably, CD4 cell counts 350–499 cells/μL were significantly associated with an increased risk compared to CD4 ≥ 500 cells/µL (adjusted hazard ratio, 1.39; 95% confidence interval, 1.01–1.89). Decreasing incidence over the last decade can be explained by increased CD4-cell counts and viral suppression and decreased smoking frequency.
Conclusions
Improvements in cascade of care of HIV and decrease in smoking may have mediated a substantial decrease in bacterial pneumonia incidence.
Funder
Swiss National Science Foundation SHCS Research Foundation Medical Faculty of the University of Zurich
Publisher
Oxford University Press (OUP)
Subject
Infectious Diseases,Immunology and Allergy
Cited by
7 articles.
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