Severe bacterial non-aids infections in HIV-positive persons: Incidence rates and risk factors

SummaryObjectivesThis study aimed to determine incidence rates (IR) and identify risk factors for severe bacterial non-AIDS infections (SBnAI) requiring hospital admission.MethodsData from the prospective EuroSIDA cohort were utilized to determine IRs of first diagnosis of the following SBnAI requiring hospital admission: bacteremia, endocarditis, meningitis, peritonitis, pneumonia, osteitis, and pyolonephritis. Incidence rate-ratios (IRRs) and risk factors were assessed by Poisson regression.ResultsDuring 35,839 person-years of follow-up (PYFU), 275 patients were diagnosed with SBnAI (IR = 7.67 per 1000 PYFU, 95% confidence interval: 6.79–8.64). The most frequent infections were pneumonia (IR = 5.36, 4.63–6.17), bacteremia (IR = 1.14, 0.82–1.55), and pyelonephritis (IR = 0.67, 0.43–1.00). A strong risk factor for SBnAI was reduced estimated glomerular filtration rate [eGFR] (adjusted IRR = 5.07, 2.12–12.1 and IRR = 2.73, 1.63–4.56 for eGFR ≤ 60 and 60.1–90 compared to eGFR > 90, respectively). No current combined antiretroviral therapy (cART) compared with current cART use increased the risk of SBnAI (adjusted IRR = 2.96, 2.03–4.32). Other risk factors for SBnAI included current CD4+ count <350 cells/μL, female gender, age, infection with HIV through IDU, prior AIDS diagnosis, and anaemia.ConclusionsEnhanced attention directed towards people with comorbidity is warranted to limit the burden of these infections.