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Community-acquired lower respiratory tract infections in HIV-infected patients on antiretroviral therapy: predictors in a contemporary cohort study

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Abstract

Community-acquired pneumonia represents the most frequent bacterial infection in patients with HIV/AIDS.

Purpose

We aimed to assess variables associated with lower respiratory tract infection (LRTI) among HIV-infected adults using ART.

Methods

A cohort study of HIV-infected patients aged ≥18 years, enrolled from 2000 to 2015, on ART for at least 60 days, with primary outcome as the 1st episode of LRTI during follow-up. The independent variables included were sex at birth, age, race/skin color, educational level, tobacco smoking, alcohol use, cocaine use, diabetes mellitus, CD4 count, HIV viral load, influenza and pneumococcal vaccination. Extended Cox proportional hazards models accounting for time-updated variables were fitted to assess LRTI predictors.

Results

2669 patients were included; median follow-up was 3.9 years per patient. LRTI was diagnosed in 384 patients; incidence rate was 30.7/1000 PY. In the unadjusted Cox extended models, non-white race [crude hazard ratio (cHR) 1.28, p = 0.020], cocaine use (cHR 2.01, p < 0.001), tobacco smoking (cHR 1.34, p value 0.007), and HIV viral load ≥400 copies/mL (cHR 3.40, p < 0.001) increased the risk of LRTI. Lower risk of LRTI was seen with higher educational level (cHR 0.61, p < 0.001), rise in CD4 counts (cHR 0.81, p < 0.001, per 100 cells/mm3 increase), influenza (cHR 0.60, p = 0.002) and pneumococcal vaccination (cHR 0.57, p < 0.001). In the adjusted model, aHR for CD4 count was 0.86, for cocaine use 1.47 and for viral load ≥400 copies 2.20.

Conclusions

LRTI has a high incidence in HIV-infected adults using ART. Higher CD4 counts and undetectable viral loads were protective, as were pneumococcal and influenza vaccines.

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Acknowledgements

We thank Dr. Michael Bruce Macrae for his assistance with language editing. This work was supported in part by the NIH-funded Caribbean, Central and South America network for HIV epidemiology (CCASAnet), a member cohort of the International Epidemiologic Databases to Evaluate AIDS (leDEA) (U01AI069923). This award is funded by the following institutes: Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Cancer Institute (NCI), National Institute Of Allergy And Infectious Diseases (NIAID), National Institute Of Mental Health (NIMH), and the Office Of The Director, National Institutes Of Health (OD).”.

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Author notes

  1. Cristiane C. Lamas and Lara E. Coelho contributed equally to this manuscript.

Authors and Affiliations

  1. Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil 4365-Manguinhos, Rio de Janeiro, RJ, CEP 21.040-900, Brazil

    Cristiane C. Lamas, Lara E. Coelho, Beatriz J. Grinsztejn & Valdilea G. Veloso

  2. Universidade do Grande Rio, Rio de Janeiro, Brazil

    Cristiane C. Lamas

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  1. Cristiane C. Lamas
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  2. Lara E. Coelho
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  3. Beatriz J. Grinsztejn
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Correspondence to Cristiane C. Lamas.

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Lamas, C.C., Coelho, L.E., Grinsztejn, B.J. et al. Community-acquired lower respiratory tract infections in HIV-infected patients on antiretroviral therapy: predictors in a contemporary cohort study. Infection 45, 801–809 (2017). https://doi.org/10.1007/s15010-017-1041-0

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