16th International AIDS Conference Toronto, Canada - August 13 - 18, 2006

TRENDS AND RISK FACTORS FOR COMMUNITY-ACQUIRED PNEUMONIA AMONG HIV-INFECTED AND HIV-UNINFECTED INTRAVENOUS DRUG USERS

Int Conf AIDS. 2006 Aug 13-18;16 Abstract No. MoAb0303

Stein K.¹, Astemborski J.², Mehta S.², Vlahov D.³, Galai N.², Kirk G.^2
1Johns Hopkins University, Department of Medicine, Baltimore, United States, ²Johns Hopkins University, Department of Epidemiology, Baltimore, United States, ³New York Academy of Medicine, New York, United States

BACKGROUND: Both HIV infection and injection drug use increase risk for community-acquired pneumonia (CAP). We examined CAP diagnoses among HIV-infected and uninfected injection drug users (IDUs) in the ALIVE study.

METHODS: From 1988 to 2004, bacterial CAP diagnoses were confirmed through record abstraction to have radiographic infiltrates and at least 1 finding of productive cough, fever, or leukocytosis; 38% had positive sputum or blood cultures. Cox time-dependent regression models were used to estimate risk for initial CAP diagnosis.

RESULTS: Among 2,833 IDUs (1,150 HIV-infected and 1,683 HIV-uninfected), 346 developed CAP; 273 were HIV-infected and 73 HIV-uninfected. CAP incidence rates declined from the pre-HAART (1988-1996) to early (1997-2000) and current (2001-04) HAART periods (2.2/100p-yrs, 1.6/100p-yrs, 0.8/100p-yrs, respectively); similar trends were observed stratified by HIV status or CD4 levels. In multivariate analyses, time-period was not significantly associated with CAP but smokers (adjRH 1.9; 95% CI, 1.3-2.8) and females (1.3; 1.0-1.7) had increased risk. Recent injection drug use (1.5; 1.2–1.9) and related complications including prior sepsis/bacteremia (4.6; 3.1–6.8) or endocarditis (2.7; 1.8–4.1) were strongly associated with CAP, while inhaled drugs had limited effect. HIV infection was strongly associated with CAP (8.5; 6.5-11.1) with increasing risk observed with progressively lower CD4 counts. Further, HIV-infected with CD4 >500 still had significantly increased risk compared to HIV-uninfected (4.1; 2.7-6.1). CAP predictors among pre-HAART HIV-infected participants were similar to HIV-uninfected (female, smoking, heavy drug use, endocarditis/bacteremia) except for the strong CD4 effect seen in all time-periods. HAART conferred a 65% reduction (0.34; 0.17-0.69) in CAP risk. Sexual behavior variables were associated with CAP but had discordant effects by HIV status.

CONCLUSIONS: CAP incidence is declining among IDUs. Among HIV-infected IDUs, CAP risk from lifestyle-related factors has diminished while effects of HIV disease status predominate. HAART greatly reduces CAP risk, but HIV-infected IDUs remain at high risk even with relatively intact immune function.

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2006-08-13
MoAb0303

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