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Details

Autor(en) / Beteiligte
Titel
Predictors of bacterial pneumonia in Evaluation of Subcutaneous Interleukin‐2 in a Randomized International Trial (ESPRIT)
Ist Teil von
  • HIV medicine, 2011-04, Vol.12 (4), p.219-227
Ort / Verlag
Oxford, UK: Blackwell Publishing Ltd
Erscheinungsjahr
2011
Link zum Volltext
Quelle
Wiley Online Library
Beschreibungen/Notizen
  • Background and Objectives Bacterial pneumonia still contributes to morbidity/mortality in HIV infection despite effective combination antiretroviral therapy (cART). Evaluation of Subcutaneous Interleukin‐2 in a Randomized International Trial (ESPRIT), a trial of intermittent recombinant interleukin‐2 (rIL‐2) with cART vs. cART alone (control arm) in HIV‐infected adults with CD4 counts ≥300 cells/μL, offered the opportunity to explore associations between bacterial pneumonia and rIL‐2, a cytokine that increases the risk of some bacterial infections. Methods Baseline and time‐updated factors associated with first‐episode pneumonia on study were analysed using multivariate proportional hazards regression models. Information on smoking/pneumococcal vaccination history was not collected. Results IL‐2 cycling was most intense in years 1–2. Over ≈7 years, 93 IL‐2 [rate 0.67/100 person‐years (PY)] and 86 control (rate 0.63/100 PY) patients experienced a pneumonia event [hazard ratio (HR) 1.06; 95% confidence interval (CI) 0.79, 1.42; P=0.68]. Median CD4 counts prior to pneumonia were 570 cells/μL (IL‐2 arm) and 463 cells/μL (control arm). Baseline risks for bacterial pneumonia included older age, injecting drug use, detectable HIV viral load (VL) and previous recurrent pneumonia; Asian ethnicity was associated with decreased risk. Higher proximal VL (HR for 1 log10 higher VL 1.28; 95% CI 1.11, 1.47; P<0.001) was associated with increased risk; higher CD4 count prior to the event (HR per 100 cells/μL higher 0.94; 95% CI 0.89, 1.0; P=0.04) decreased risk. Compared with controls, the hazard for a pneumonia event was higher if rIL‐2 was received <180 days previously (HR 1.66; 95% CI 1.07, 2.60; P=0.02) vs.≥180 days previously (HR 0.98; 95% CI 0.70, 1.37; P=0.9). Compared with the control group, pneumonia risk in the IL‐2 arm decreased over time, with HRs of 1.41, 1.71, 1.16, 0.62 and 0.84 in years 1, 2, 3–4, 5–6 and 7, respectively. Conclusions Bacterial pneumonia rates in cART‐treated adults with moderate immunodeficiency are high. The mechanism of the association between bacterial pneumonia and recent IL‐2 receipt and/or detectable HIV viraemia warrants further exploration.

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