1 Infectious Diseases, Department of Clinical Research, Det Sundhedsvidenskabelige Fakultet, SDU2 Statens Serum Institut3 Copenhagen University Hospital4 Department of Infectious Diseases and Clinical Research Center, Copenhagen University Hospital, Hvidovre Faculty of Health and Medical Sciences, University of Copenhagen.5 Department of Infectious Diseases, Righospitalet.6 Aarhus Universitetshospital7 Aalborg Universitetshospital8 Infektionsmedicin, Department of Clinical Research, Det Sundhedsvidenskabelige Fakultet, SDU9 Infectious Diseases, Department of Clinical Research, Det Sundhedsvidenskabelige Fakultet, SDU10 Infektionsmedicin, Department of Clinical Research, Det Sundhedsvidenskabelige Fakultet, SDU
Persisting High Risk among HIV-infected Injecting Drug Users
BACKGROUND: Invasive pneumococcal disease (IPD) is an important cause of morbidity among HIV-infected individuals. We described incidence and risk factors for IPD in HIV-infected and uninfected individuals. METHODS: Nationwide population-based cohort study of HIV-infected adults treated at all Danish HIV-treatment centers during 1995-2012. Nineteen population-matched controls per HIV-infected individual were retrieved. The risk of IPD (RR, [95% CI]) was assessed using Poisson regression. RESULTS: The incidence of IPD was 304.7 cases/100,000 PYFU in HIV-infected and 12.8/100,000 PYFU in HIV-uninfected individuals. After adjusting for confounders, HIV-infection (RR 24.4 [23.7-25.1]), male sex (RR 1.20 [1.16-1.24]), increasing age (per year) (RR 1.03 [1.03-1.04]) and calendar period (pre-cART [RR 2.80 [2.70-2.91] compared to late cART) were significantly associated with an increased risk of IPD. Among HIV-infected individuals, male sex (RR 1.57 [1.49-1.66]), smoking (RR 1.34 [1.26-1.42]), and intravenous drug use (RR 2.51 [2.26-2.67]) were associated with an increased risk of IPD. Detectable viral loads (RR 1.88 [1.79-1.98]) and a relative fall in CD4 T-cell counts were also associated with an increased risk (≥500 to 350-<500 CD4 T-cells/µl RR 1.29 [1.21-1.37], and <100 cells/µl RR 7.4 [6.87-8.02]). The risk of IPD declined over time though this was not the case for IDUs where the risk remained unchanged. CONCLUSIONS: The incidence of IPD in HIV-infected individuals remained significantly higher than the incidence observed in non-HIV-infected, in spite of the widespread use of cART. IDUs have a persisting high risk of IPD. IDU, smoking, the receipt of cART are suitable targets for preventive measures in the future.
Clinical Infectious Diseases, 2014, Vol 59, Issue 8, p. 1168-1176