Corticosteroids Use and Incidence of Severe Infections in People Living with HIV Compared to a Matched Population
Background: People living with HIV (PLWH) have been shown to have an increased risk of autoimmune diseases. Corticosteroids are the cornerstone of autoimmune diseases treatment, but their use is associated with an increased risk of infections. It is unclear how HIV status affects the risk of infecti...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2022-06-01
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| Series: | Journal of the International Association of Providers of AIDS Care |
| Online Access: | https://doi.org/10.1177/23259582221107196 |
| _version_ | 1811250065708154880 |
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| author | Joseph Junior Damba MD, MSc Mikhael Laskine MD, MSc Marc Messier Peet MSc Yulan Jin MA Liliya Sinyavskaya MD Madeleine Durand MD, MSc |
| author_facet | Joseph Junior Damba MD, MSc Mikhael Laskine MD, MSc Marc Messier Peet MSc Yulan Jin MA Liliya Sinyavskaya MD Madeleine Durand MD, MSc |
| author_sort | Joseph Junior Damba MD, MSc |
| collection | DOAJ |
| description | Background: People living with HIV (PLWH) have been shown to have an increased risk of autoimmune diseases. Corticosteroids are the cornerstone of autoimmune diseases treatment, but their use is associated with an increased risk of infections. It is unclear how HIV status affects the risk of infection associated with corticosteroids use. Methods: We conducted a retrospective cohort study from 1991 to 2011, using a medico-administrative database from Quebec. Medical billing codes were used to identify PLWH, and we matched them on age, sex, and index date with up to 4 HIV-negative controls. The exposure of interest was the use of corticosteroids, defined as a systemic corticosteroid dispensation lasting at least 20 days. The outcome of interest was hospitalization for severe infection. Crude and adjusted incidence rates ratios of infection were obtained using a random effect Poisson model, and results were stratified by HIV status. Results: In total, 4798 PLWH were matched to 17 644 HIV-negative controls, among which 1083 (22.6%) PLWH and 1854 (10.5%) HIV-negative controls received at least one course of corticosteroid. The mean duration of corticosteroids use was 4 ± 4.4 months in PLWH and 1.6 ± 5.5 months in HIV-negative controls. The incidence rate ratio (IRR) for infections associated with corticosteroids use was 2.49[1.71–3.60] in PLWH and 1.32[0.71–2.47] in HIV-negative controls (P value for interaction 0.18). The most frequent infections were pulmonary infections (50.4%), followed by urinary tract infections (26%) and opportunistic infections (10.5%). Conclusion: Although our interaction term did not reach significance, the increased risk of infection associated with corticosteroids use was more pronounced in PLWH. However, further research with contemporary data is warranted to confirm if the risk associated with corticosteroids use remains high in PLWH with well-controlled HIV infection. |
| first_indexed | 2024-04-12T15:57:30Z |
| format | Article |
| id | doaj.art-c359ffbafe1e42989bee9893921407be |
| institution | Directory Open Access Journal |
| issn | 2325-9582 |
| language | English |
| last_indexed | 2024-04-12T15:57:30Z |
| publishDate | 2022-06-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Journal of the International Association of Providers of AIDS Care |
| spelling | doaj.art-c359ffbafe1e42989bee9893921407be2022-12-22T03:26:18ZengSAGE PublishingJournal of the International Association of Providers of AIDS Care2325-95822022-06-012110.1177/23259582221107196Corticosteroids Use and Incidence of Severe Infections in People Living with HIV Compared to a Matched PopulationJoseph Junior Damba MD, MSc0Mikhael Laskine MD, MSc1Marc Messier Peet MSc2Yulan Jin MA3Liliya Sinyavskaya MD4Madeleine Durand MD, MSc5 Centre de recherche du centre hospitalier universitaire de Montréal (CRCHUM), Montréal, Québec, Canada Internal Medicine Service, Centre hospitalier universitaire de Montréal (CHUM), Montréal, Québec, Canada Centre de recherche du centre hospitalier universitaire de Montréal (CRCHUM), Montréal, Québec, Canada Centre de recherche du centre hospitalier universitaire de Montréal (CRCHUM), Montréal, Québec, Canada Centre de recherche du centre hospitalier universitaire de Montréal (CRCHUM), Montréal, Québec, Canada Internal Medicine Service, Centre hospitalier universitaire de Montréal (CHUM), Montréal, Québec, CanadaBackground: People living with HIV (PLWH) have been shown to have an increased risk of autoimmune diseases. Corticosteroids are the cornerstone of autoimmune diseases treatment, but their use is associated with an increased risk of infections. It is unclear how HIV status affects the risk of infection associated with corticosteroids use. Methods: We conducted a retrospective cohort study from 1991 to 2011, using a medico-administrative database from Quebec. Medical billing codes were used to identify PLWH, and we matched them on age, sex, and index date with up to 4 HIV-negative controls. The exposure of interest was the use of corticosteroids, defined as a systemic corticosteroid dispensation lasting at least 20 days. The outcome of interest was hospitalization for severe infection. Crude and adjusted incidence rates ratios of infection were obtained using a random effect Poisson model, and results were stratified by HIV status. Results: In total, 4798 PLWH were matched to 17 644 HIV-negative controls, among which 1083 (22.6%) PLWH and 1854 (10.5%) HIV-negative controls received at least one course of corticosteroid. The mean duration of corticosteroids use was 4 ± 4.4 months in PLWH and 1.6 ± 5.5 months in HIV-negative controls. The incidence rate ratio (IRR) for infections associated with corticosteroids use was 2.49[1.71–3.60] in PLWH and 1.32[0.71–2.47] in HIV-negative controls (P value for interaction 0.18). The most frequent infections were pulmonary infections (50.4%), followed by urinary tract infections (26%) and opportunistic infections (10.5%). Conclusion: Although our interaction term did not reach significance, the increased risk of infection associated with corticosteroids use was more pronounced in PLWH. However, further research with contemporary data is warranted to confirm if the risk associated with corticosteroids use remains high in PLWH with well-controlled HIV infection.https://doi.org/10.1177/23259582221107196 |
| spellingShingle | Joseph Junior Damba MD, MSc Mikhael Laskine MD, MSc Marc Messier Peet MSc Yulan Jin MA Liliya Sinyavskaya MD Madeleine Durand MD, MSc Corticosteroids Use and Incidence of Severe Infections in People Living with HIV Compared to a Matched Population Journal of the International Association of Providers of AIDS Care |
| title | Corticosteroids Use and Incidence of Severe Infections in People Living with HIV Compared to a Matched Population |
| title_full | Corticosteroids Use and Incidence of Severe Infections in People Living with HIV Compared to a Matched Population |
| title_fullStr | Corticosteroids Use and Incidence of Severe Infections in People Living with HIV Compared to a Matched Population |
| title_full_unstemmed | Corticosteroids Use and Incidence of Severe Infections in People Living with HIV Compared to a Matched Population |
| title_short | Corticosteroids Use and Incidence of Severe Infections in People Living with HIV Compared to a Matched Population |
| title_sort | corticosteroids use and incidence of severe infections in people living with hiv compared to a matched population |
| url | https://doi.org/10.1177/23259582221107196 |
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