BACKGROUND Bacterial pneumonia is a leading reason for hospitalization among people with HIV (PWH); however, evidence regarding its drivers in the era of potent antiretroviral therapy is limited. METHODS We assessed risk factors for bacterial pneumonia in the Swiss HIV Cohort Study using marginal models. We further assessed the relationship between risk factors and changes in bacterial pneumonia incidence using mediation analysis. RESULTS We included 12927 PWH with follow-ups between 2008 and 2018. These patients had 985 bacterial pneumonia events during a follow-up of 100779 person-years. Bacterial pneumonia incidence significantly decreased from 13.2 cases/1000 person-years in 2008 to 6.8 cases/1000 person-years in 2018. Older age, lower education level, intravenous drug use, smoking, lower CD4-cell count, higher HIV load, and prior pneumonia were significantly associated with higher bacterial pneumonia incidence. Notably, CD4 cell counts 350-499 cells/μL were significantly associated with an increased risk compared to CD4 ≥ 500 cells/µL (adjusted hazard ratio, 1.39; 95% confidence interval, 1.01-1.89). Decreasing incidence over the last decade can be explained by increased CD4-cell counts and viral suppression and decreased smoking frequency. CONCLUSIONS Improvements in cascade of care of HIV and decrease in smoking may have mediated a substantial decrease in bacterial pneumonia incidence.

中文翻译：

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减少 HIV 感染者细菌性肺炎的发病率和决定因素：瑞士 HIV 队列研究。

背景 细菌性肺炎是 HIV 感染者 (PWH) 住院的主要原因。然而，关于其在强效抗逆转录病毒疗法时代的驱动力的证据是有限的。方法 我们在瑞士 HIV 队列研究中使用边缘模型评估了细菌性肺炎的危险因素。我们使用中介分析进一步评估了风险因素与细菌性肺炎发病率变化之间的关系。结果 我们纳入了 2008 年至 2018 年间随访的 12927 名 PWH。这些患者在 100779 人年的随访期间发生了 985 起细菌性肺炎事件。细菌性肺炎发病率从 2008 年的 13.2 例/1000 人年显着下降至 2018 年的 6.8 例/1000 人年。先前的肺炎与较高的细菌性肺炎发病率显着相关。值得注意的是，与 CD4 ≥ 500 个细胞/μL 相比，CD4 细胞计数 350-499 个细胞/μL 与风险增加显着相关（调整后的风险比，1.39；95% 置信区间，1.01-1.89）。过去十年发病率的下降可以用 CD4 细胞计数增加和病毒抑制以及吸烟频率降低来解释。结论 HIV 级联护理的改善和吸烟的减少可能导致细菌性肺炎发病率显着下降。过去十年发病率的下降可以用 CD4 细胞计数增加和病毒抑制以及吸烟频率降低来解释。结论 HIV 级联护理的改善和吸烟的减少可能导致细菌性肺炎发病率显着下降。过去十年发病率的下降可以用 CD4 细胞计数增加和病毒抑制以及吸烟频率降低来解释。结论 HIV 级联护理的改善和吸烟的减少可能导致细菌性肺炎发病率显着下降。