Risk of severe bacterial infection in people living with HIV infection in the cART era.

BACKGROUND: Severe bacterial infections are the first cause of morbidity in people with HIV (PWH). We aimed to assess their incidence and to analyze their determinants. METHODS: We studied HIV-1-infected individuals aged at least 15 years and prospectively followed between 2006 and 2015 in the French Hospital Database on HIV. The Andersen and Gill model was used to calculate the adjusted hazard ratios (HRs), focusing on heavy alcohol use and neutrophil function-altering comorbidities. RESULTS: Out of 25,795 participants, 1414 developed 1883 severe bacterial infections. Between 2006-2009 and 2013-2015, the incidence fell from 13.2 (95% confidence interval, CI, 12.3-14.1) to 7.1 (95%CI, 6.3-7.8) per 1000 person-years. Heavy alcohol use was associated with an increased risk of severe bacterial infection (HR 1.3, 95% CI 1.1-1.7 for 40-80 g/day and 1.6, 95% CI 1.2-2.1 for > 80 g/day), as were diabetes, chronic kidney disease and end stage liver disease (HR 1.2, 95%CI, 1.0-1.4, when one and 2.3, 95%CI, 1.6-3.4 when more than one comorbidity), and non-AIDS-defining malignancy (HR 2.0, 95%CI: 1.6-2.4). CONCLUSIONS: Heavy alcohol use was associated with an increased risk of severe bacterial infection, as were neutrophil function-altering comorbidities. Controlled-drinking approaches should be promoted and comorbidity management should be strengthened in PWH.