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

Abstract

Background Bacterial pneumonia is one of the leading reasons for hospitalization among people with HIV (PWH), yet there is limited evidence regarding its drivers in the era of potent antiretroviral therapy. Methods We assessed risk-factors for bacterial pneumonia in PWH enrolled in the Swiss HIV Cohort Study using univariable and multivariable 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(py). bacterial pneumonia incidence significantly decreased from 13.2 cases/1000 py in 2008 to 6.8 cases/1000 py in 2018. Older age, lower education-level, intravenous drug use, smoking, lower CD4-cell-count, higher HIV-viral load, and prior pneumonia events were significantly associated with higher bacterial pneumonia incidence. Notably, even CD4-cell-counts 350-499 were significantly associated with an increased risk compared to CD4≥500 (adjusted HR,1.39; 95% CI,1.01-1.89). Finally, we found that the decreasing incidence over the last decade can be explained by decreasing proportion of patients with CD4<500, viral-RNA>200, and smoking>one cigarette/day. Conclusion Improvements in cascade of care of HIV and decrease in smoking may have mediated a substantial decrease in bacterial pneumonia incidence.

Characterization and Determinants of Long-Term Immune Recovery Under Suppressive Antiretroviral Therapy

“…All logistic regression models were further adjusted for age, sex, study center, ethnicity, body mass index, smoking pack-years, 32 presence of a positive hepatitis C test, time at risk, time since positive HIV test, and time since ART initiation. Bacterial pneumonia was chosen for its relative commonality as an opportunistic infection in PWH because we were limited by the number of clinical events recorded in the observation period.…”

COPD in People with HIV: Epidemiology, Pathogenesis, Management, and Prevention Strategies

“…PWH have historically had higher rates of pneumonia, and while incidence of bacterial pneumonia has decreased with the advent of ART, 80,81 it remains common in this population. [82][83][84] In the current era, PWH have similar rates of acute respiratory infections as people without HIV, but PWH experience more severe disease.…”

A cross-sectional study of attitudes and behaviors of snuff use and cessation among people with and without HIV in South Africa

“… 7 In general, women of lower socioeconomic status and lower education levels have a higher prevalence of snuff use, 7 and in Africa, the prevalence of SLT use is approximately 34% higher among people with HIV (PWH) as compared to those without HIV. 11 , 12 Tobacco use among PWH is of particular concern as it increases the risk of disease, including bacterial pneumonia, 13 chronic obstructive pulmonary disease, 14 cardiovascular disease, 15 TB, 16 and cancer, 17 for which PWH are already susceptible. Further, tobacco smoking among PWH may increase immune activation and exhaustion when compared to non-smoking PWH and HIV-negative individuals, which may increase the risk of developing infections, 18 and daily tobacco use may decrease the immune and virological response to ART.…”