Université de Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health Research Centre, 33000 Bordeaux, France.
Université de Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health Research Centre, 33000 Bordeaux, France; CHU de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Hôpital Saint-André, 33000 Bordeaux, France; CHU de Bordeaux, COREVIH Nouvelle Aquitaine, 33000 Bordeaux, France.
Clin Microbiol Infect. 2021 Sep;27(9):1301-1307. doi: 10.1016/j.cmi.2020.11.019. Epub 2020 Dec 1.
Bacterial infections remain one of the main causes of morbidity and death in people living with HIV (PLHIV) in the most recent years. Several studies have demonstrated a protective effect of statins in the primary prevention of bacterial infections in other immunocompromised populations, but this effect remains controversial. The objective of this study was to evaluate the effect of statin use on the occurrence of a first episode of severe bacterial infection (SBI) in PLHIV in the ANRS CO3 Aquitaine cohort between 2000 and 2018.
All individuals included in the prospective ANRS CO3 Aquitaine cohort who had at least two follow-up visits between 2000 and 2018 were included. The primary endpoint was the occurrence of a first episode of bacterial infection leading to hospitalization of ≥48 hours or death. Statin exposure was updated during follow-up. Marginal Cox structural models were developed to consider the potential indication bias and time-dependent confusion. Numerous sensitivity analyses were carried out.
In this study 51 658 person-years were followed. The overall incidence of a first episode of SBI was 12.4/1000 person-years. No effect of statins on the occurrence of SBI was demonstrated when subjects were considered on statins throughout their follow-up after treatment initiation (HR = 0.97; 95%CI: 0.75-1.25). The results were similar for the effect of statins on the risk of pneumonia and for all sensitivity analyses.
In this large cohort of PLHIV with 18 years of follow-up and a high risk of severe infections, we found no effect of statins on the risk of occurrence of SBI or pneumonia.
近年来，细菌感染仍然是导致 HIV 感染者（PLHIV）发病和死亡的主要原因之一。多项研究表明他汀类药物在其他免疫功能低下人群中的细菌感染一级预防中具有保护作用，但这种作用仍存在争议。本研究旨在评估他汀类药物的使用对 2000 年至 2018 年期间 ANRS CO3 阿基坦队列中 PLHIV 首次发生严重细菌感染（SBI）的影响。
所有纳入前瞻性 ANRS CO3 阿基坦队列的个体，在 2000 年至 2018 年期间至少有两次随访，均被纳入本研究。主要终点是发生首次导致住院时间≥48 小时或死亡的细菌感染。在随访期间更新他汀类药物的暴露情况。使用边缘 Cox 结构模型来考虑潜在的适应证偏倚和时变混杂。进行了大量敏感性分析。
本研究共随访了 51658 人年。首次发生 SBI 的总体发生率为 12.4/1000 人年。在开始治疗后整个随访期间，无论他汀类药物的使用情况如何，他汀类药物对 SBI 的发生均无影响（HR=0.97；95%CI：0.75-1.25）。他汀类药物对肺炎风险的影响以及所有敏感性分析的结果均相似。
在这项对 18 年随访、严重感染风险高的 PLHIV 的大型队列研究中，我们未发现他汀类药物对 SBI 或肺炎发生风险有影响。
