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https://www.arca.fiocruz.br/handle/icict/25431
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ArticleCopyright
Open access
Embargo date
2018-06-30
Sustainable Development Goals
03 Saúde e Bem-EstarCollections
- INI - Artigos de Periódicos [3488]
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COMMUNITY-ACQUIRED LOWER RESPIRATORY TRACT INFECTIONS IN HIV-INFECTED PATIENTS ON ANTIRETROVIRAL THERAPY: PREDICTORS IN A CONTEMPORARY COHORT STUDY
Affilliation
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / Universidade do Grande Rio. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.
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 HIVinfected 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, infuenza and pneumococcal vaccination. Extended Cox proportional hazards models accounting for time-updated variables were ftted to assess LRTI predictors. Results 2669 patients were included; median followup 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), infuenza (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 infuenza vaccines.
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