HIV感染者中细菌性肺炎发病率的下降及其决定因素：瑞士HIV队列研究

Decreasing Incidence and Determinants of Bacterial Pneumonia in People With HIV: The Swiss HIV Cohort Study.

作者信息

Balakrishna Suraj, Wolfensberger Aline, Kachalov Viacheslav, Roth Jan A, Kusejko Katharina, Scherrer Alexandra U, Furrer Hansjakob, Hauser Christoph, Calmy Alexandra, Cavassini Matthias, Schmid Patrick, Bernasconi Enos, Battegay Manuel, Günthard Huldrych F, Kouyos Roger D

机构信息

Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.

Institute of Medical Virology, University of Zurich, Zurich, Switzerland.

出版信息

J Infect Dis. 2022 May 4;225(9):1592-1600. doi: 10.1093/infdis/jiab573.

DOI:10.1093/infdis/jiab573

PMID:34792153

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.

摘要

背景

细菌性肺炎是艾滋病毒感染者（PWH）住院的主要原因；然而，在强效抗逆转录病毒治疗时代，关于其驱动因素的证据有限。

方法

我们在瑞士艾滋病毒队列研究中使用边际模型评估了细菌性肺炎的风险因素。我们还使用中介分析评估了风险因素与细菌性肺炎发病率变化之间的关系。

结果

我们纳入了12927名在2008年至2018年期间接受随访的艾滋病毒感染者。这些患者在100779人年的随访期间发生了985例细菌性肺炎事件。细菌性肺炎发病率从2008年的13.2例/1000人年显著下降至2018年的6.8例/1000人年。年龄较大、教育水平较低、静脉吸毒、吸烟、CD4细胞计数较低、艾滋病毒载量较高以及既往有肺炎与细菌性肺炎发病率较高显著相关。值得注意的是，与CD4≥500个细胞/µL相比，CD4细胞计数为350 - 499个细胞/μL与风险增加显著相关（调整后的风险比为1.39；95%置信区间为1.01 - 1.89）。过去十年发病率的下降可以通过CD4细胞计数增加、病毒抑制以及吸烟频率降低来解释。