title: Incidence and Risk Factors for Severe Bacterial Infections in People Living with HIV. ANRS CO3 Aquitaine Cohort, 2000-2012.
abstract: Severe non-AIDS bacterial infections (SBI) are the leading cause of hospital admissions among people living with HIV (PLHIV) in industrialized countries. We aimed to estimate the incidence of SBI and their risk factors in a large prospective cohort of PLHIV patients over a 13-year period in France. Patients followed up in the ANRS CO3 Aquitaine cohort between 2000 and 2012 were eligible; SBI was defined as a clinical diagnosis associated with hospitalization of ≥48 hours or death. Survival analysis was conducted to identify risk factors for SBI.Total follow-up duration was 39,256 person-years [PY] (31,370 PY on antiretroviral treatment [ART]). The incidence of SBI decreased from 26.7/1000 PY [95% CI: 22.9-30.5] over the period 2000-2002 to 11.9/1000 PY [10.1-13.8] in 2009-2012 (p <0.0001). Factors independently associated to increased risk of SBI were: plasma HIVRNA>50 copies/mL (Hazard Ratio [HR] = 5.1, 95% Confidence Interval: 4.2-6.2), CD4 count <500 cells/mm3 and CD4/CD8 ratio <0.8 (with a dose-response relationship for both markers), history of cancer (HR = 1.4 [1.0-1.9]), AIDS stage (HR = 1.7 [1.3-2.1]) and HCV coinfection (HR = 1.4, [1.1-1.6]). HIV-positive patients with diabetes were more prone to SBI (HR = 1.6 [0.9-2.6]). Incidence of SBI decreased over a 13-year period due to the improvement in the virological and immune status of PLHIV on ART. Risk factors for SBI include low CD4 count and detectable HIV RNA, but also CD4/CD8 ratio, HCV coinfection, history of cancer and diabetes, comorbid conditions that have been frequent among PLHIV in recent years.
authors.affiliation: Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination régionale de la lutte contre l'infection à VIH (COREVIH), Bordeaux, France.|CHU Bordeaux, Services de médecine interne et maladies infectieuses, Bordeaux, France.
authors.forename: Amandine
authors.initials: A
authors.lastname: Collin
authors.affiliation: Université de Bordeaux, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique Rue Léo Saignat, Bordeaux, France.|INSERM U897, Centre Inserm Epidémiologie et Biostatistique, Université de Bordeaux, Rue Léo Saignat, Bordeaux, France.
authors.forename: Fabien
authors.initials: F
authors.lastname: Le Marec
authors.affiliation: Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination régionale de la lutte contre l'infection à VIH (COREVIH), Bordeaux, France.|CHU Bordeaux, Services de médecine interne et maladies infectieuses, Bordeaux, France.|Université de Bordeaux, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique Rue Léo Saignat, Bordeaux, France.|INSERM U897, Centre Inserm Epidémiologie et Biostatistique, Université de Bordeaux, Rue Léo Saignat, Bordeaux, France.
authors.forename: Marie-Anne
authors.initials: MA
authors.lastname: Vandenhende
authors.affiliation: Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination régionale de la lutte contre l'infection à VIH (COREVIH), Bordeaux, France.|CHU Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Pessac, France.
authors.forename: Estibaliz
authors.initials: E
authors.lastname: Lazaro
authors.affiliation: Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination régionale de la lutte contre l'infection à VIH (COREVIH), Bordeaux, France.|CHU Bordeaux, Services de médecine interne et maladies infectieuses, Bordeaux, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Duffau
authors.affiliation: Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination régionale de la lutte contre l'infection à VIH (COREVIH), Bordeaux, France.|CHU Bordeaux, Fédération de maladies infectieuses et tropicales, Bordeaux, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Cazanave
authors.affiliation: Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination régionale de la lutte contre l'infection à VIH (COREVIH), Bordeaux, France.|CH de Dax, Service de Maladies Infectieuses, Dax, France.
authors.forename: Yann
authors.initials: Y
authors.lastname: Gérard
authors.affiliation: Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination régionale de la lutte contre l'infection à VIH (COREVIH), Bordeaux, France.|Université de Bordeaux, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique Rue Léo Saignat, Bordeaux, France.|INSERM U897, Centre Inserm Epidémiologie et Biostatistique, Université de Bordeaux, Rue Léo Saignat, Bordeaux, France.
authors.forename: François
authors.initials: F
authors.lastname: Dabis
authors.affiliation: Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination régionale de la lutte contre l'infection à VIH (COREVIH), Bordeaux, France.|Université de Bordeaux, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique Rue Léo Saignat, Bordeaux, France.|INSERM U897, Centre Inserm Epidémiologie et Biostatistique, Université de Bordeaux, Rue Léo Saignat, Bordeaux, France.
authors.forename: Mathias
authors.initials: M
authors.lastname: Bruyand
authors.affiliation: Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination régionale de la lutte contre l'infection à VIH (COREVIH), Bordeaux, France.|CHU Bordeaux, Services de médecine interne et maladies infectieuses, Bordeaux, France.|Université de Bordeaux, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique Rue Léo Saignat, Bordeaux, France.|INSERM U897, Centre Inserm Epidémiologie et Biostatistique, Université de Bordeaux, Rue Léo Saignat, Bordeaux, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bonnet
mesh_terms: D000328:Adult; D001424:Bacterial Infections / Q000150:complications*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications*; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D019562:Viral Load