目的:我们旨在确定发病率,病原体组成,和风险因素,特别是气流限制,在2015-2021年间接受良好治疗的PWH的前瞻性队列中,与细菌性呼吸道感染和肺炎相关。
方法:我们纳入了哥本哈根HIV感染合并症(COCOMO)研究的1007个PWH。在纳入时进行肺活量测定。前瞻性地收集微生物学样本。累积发病率由Aalen-Johansen估计器确定。Cox比例风险模型用于计算危险因素,针对传统变量和艾滋病毒特异性变量进行了调整。
结果:首次细菌性呼吸道感染和肺炎的发病率分别为12.4[95CI9.7-15.5]和5.5[95CI:3.8-7.7]/1000人年,分别。在气流受限的PWH中,肺炎的累积发病率高出四倍(11.8%vs.3.2%,p<0.001)。细菌性呼吸道感染的危险因素是气流受限(HR2.9,[95CI:1.7-5.1],p<0.001),吸烟(HR2.3,[95CI:1.4-3.8],p<0.001),和先前的艾滋病定义事件(HR2.0,[95CI:1.2-3.3],p=0.009)。对于肺炎,气流限制(HR2.7,[95CI:1.2-6.3],p=0.016),吸烟(HR2.5,[95CI:1.2-5.4],p=0.016),和年龄较大(HR1.5,[95CI:1.1-2.1],p=0.015)被确定为危险因素。
结论:更加重视气流受限预防,包括戒烟,可以减轻PWH中细菌性呼吸道感染和肺炎的负担。
OBJECTIVE: We aimed to determine the incidence rate, pathogen composition, and risk factors, particularly airflow limitation, associated with bacterial respiratory infection and pneumonia in a prospective cohort of well-treated people with HIV (PWH) between 2015-2021.
METHODS: We included 1007 PWH from the Copenhagen Comorbidity in HIV infection (COCOMO) study. Spirometry was performed at inclusion. Microbiology samples were collected prospectively. Cumulative incidence was determined by the Aalen-Johansen estimator. Cox proportional hazard models were used to calculate risk factors, adjusted for traditional and HIV-specific variables.
RESULTS: The incidence rates of first bacterial respiratory infection and pneumonia were 12.4 (95% CI 9.7-15.5) and 5.5 (95% CI: 3.8-7.7) per 1000 person-years, respectively. The cumulative incidence of pneumonia was four times higher in PWH with airflow limitation (11.8% vs 3.2%, P <0.001). Risk factors for bacterial respiratory infection were airflow limitation (hazard ratio [HR] 2.9, [95% CI: 1.7-5.1], P <0.001), smoking (HR 2.3, [95% CI: 1.4-3.8], P <0.001), and previous AIDS-defining event (HR 2.0, [95% CI: 1.2-3.3], P = 0.009). For pneumonia, airflow limitation (HR 2.7, [95% CI: 1.2-6.3], P = 0.016), smoking (HR 2.5, [95% CI: 1.2-5.4], P = 0.016), and older age (HR 1.5, [95% CI: 1.1-2.1], P = 0.015) were identified as risk factors.
CONCLUSIONS: Increased emphasis on airflow limitation prevention, including smoking cessation, may reduce the burden of bacterial respiratory infection and pneumonia in PWH.