Incidence and Risk Factors for Severe Bacterial Infections in People Living with HIV. ANRS CO3 Aquitaine Cohort, 2000–2012

Abstract

Severe non-AIDS bacterial infections (SBI) are the leading cause of hospital admissions among people living with HIV (PLHIV) in industrialized countries. We aimed to estimate the incidence of SBI and their risk factors in a large prospective cohort of PLHIV patients over a 13-year period in France. Patients followed up in the ANRS CO3 Aquitaine cohort between 2000 and 2012 were eligible; SBI was defined as a clinical diagnosis associated with hospitalization of ≥48 hours or death. Survival analysis was conducted to identify risk factors for SBI.Total follow-up duration was 39,256 person-years [PY] (31,370 PY on antiretroviral treatment [ART]). The incidence of SBI decreased from 26.7/1000 PY [95% CI: 22.9–30.5] over the period 2000–2002 to 11.9/1000 PY [10.1–13.8] in 2009–2012 (p <0.0001). Factors independently associated to increased risk of SBI were: plasma HIVRNA>50 copies/mL (Hazard Ratio [HR] = 5.1, 95% Confidence Interval: 4.2–6.2), CD4 count <500 cells/mm3 and CD4/CD8 ratio <0.8 (with a dose-response relationship for both markers), history of cancer (HR = 1.4 [1.0–1.9]), AIDS stage (HR = 1.7 [1.3–2.1]) and HCV coinfection (HR = 1.4, [1.1–1.6]). HIV-positive patients with diabetes were more prone to SBI (HR = 1.6 [0.9–2.6]). Incidence of SBI decreased over a 13-year period due to the improvement in the virological and immune status of PLHIV on ART. Risk factors for SBI include low CD4 count and detectable HIV RNA, but also CD4/CD8 ratio, HCV coinfection, history of cancer and diabetes, comorbid conditions that have been frequent among PLHIV in recent years.

Eradication of hepatitis C virus and non‐liver‐related non–acquired immune deficiency syndrome–related events in human immunodeficiency virus/hepatitis C virus coinfection

“…As for liver cirrhosis, the only identified factor for bacterial infections is advanced liver disease . In the cART era, HCV infection has been shown to predispose to severe bacterial infections associated with hospitalization or death in HIV‐infected individuals . However, we did not find a significant association between response to anti‐HCV treatment and the hazard of non‐AIDS‐related infections.…”

Impact of the M184V/I Mutation on the Efficacy of Abacavir/Lamivudine/Dolutegravir Therapy in HIV Treatment-Experienced Patients

“…We conducted an observational longitudinal analysis of prospectively collected data from 5 different HIV European cohorts: (1) ANRS-CO3 Aquitaine for HIV-positive French patients [15]; (2) Antiviral Response Cohort Analysis (ARCA) containing data on HIV resistance in Italy [16]; (3) AIDS Therapy Evaluation in the Netherlands (ATHENA) [17]; (4) the Italian Cohort of Antiretroviral-Naïve Patients (ICONA) [18]; and (5) the Swiss HIV Cohort Study (SHCS) [19]. All patients provided informed consent for the use of their clinical and laboratory data for research purposes according to country-specific requirements.…”

Outcomes Among HIV-Positive Patients Hospitalized With COVID-19

“… 11 – 15 Risk factors associated with contracting severe non-AIDS bacterial infections include immunosuppression and a history of cancer and diabetes, comorbidities that have also been associated with worse prognosis in SARS-CoV-2 infection. 2 , 8 , 16 This study was not powered to conclude that superimposed bacterial infections were a predictor of mortality in HIV-positive patients with SARS-CoV-2 infection. However, all HIV-positive patients with a bacterial pneumonia died, and this finding should be considered when making clinical decisions about these patients.…”