Objective
To ascertain the relationship between periods of various antiretroviral therapies and the incidence of first community‐acquired pneumococcal pneumonia (CAPP) among HIV‐1 infected patients.
Methods
We analysed 4075 patients enrolled prospectively in the Lyon section of the French Hospital Database on HIV between 1993 and 2004, stratified into three groups. The first group (G1) included patients for whom enrolment and last follow‐up were before the highly active antiretroviral therapy (HAART) period (beginning 1 July 1996); the second group (G2) comprised patients who were enrolled before HAART but had last follow‐up in the HAART period; the third group (G3) included patients for whom both enrolment and last follow‐up took place in the HAART period.
Results
Fifty‐five CAPP episodes were identified. The incidence of CAPP per 1000 patient‐years declined over time, from 10.6 to 1.5 and 2.5 in calendar periods G1, G2 and G3, respectively (P=0.004 for linear trend). Factors associated with a decreased risk of CAPP were lower age, baseline CD4 count ≥200 cells/μL and more recent years of enrolment, when HAART use became extensive (P<0.001). The use of intravenous drugs increased the risk of CAPP (P<0.001).
Conclusions
There has been a significant reduction in the incidence of CAPP in HIV‐1 infected patients since the advent of HAART.
These results, obtained by continuous epidemiological monitoring of nosocomial infections, are encouraging with regard to the improvement of infection control measures and the evolution of medical practices. Further studies in ICUs are needed to confirm this trend.
The rate of HIV disease progression is associated with the severity of the acute retroviral syndrome (ARS). We explored the clinical features of ARS by gender, age and route of infection among 378 individuals with documented ARS enrolled in 5 prospective cohort studies with similar enrollment criteria. No major differences were detected by gender or by age. Several symptoms were reported less frequently in the injecting drug users as compared with infection acquired through sexual contacts (either heterosexual or homosexual). This was observed in particular for fever (50% vs. 77%, p=.001), skin rash (21% vs. 51%, p=.001), pharyngitis (18% vs. 43%, p=.004), and myalgia (29% vs. 52%, p=.01). Genital ulcerations were present only in cases of sexual exposure to HIV. Injecting drug users had or reported symptoms associated with the ARS less frequently than persons acquiring HIV via sexual transmission.
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