As noted, greater immunosuppression was also associated with a stepwise increased
likelihood of bacteraemia. Compared with those with CD4 BAY 73-4506 cost counts >500 cells/μL, those with CD4 counts of 201–350 cells/μL (AOR 1.77, 95% CI 1.46, 2.15), 51–200 cells/μL (AOR 3.23, 95% CI 2.65, 3.94) and ≤50 cells/μL (AOR 7.64, 95% CI 6.14, 9.51) had higher odds of bacteraemia. In addition, compared with those with HIV-1 RNA ≤400 copies/mL, those with higher HIV-1 RNA levels had higher odds of bacteraemia. The likelihood of bacteraemia was higher among IDUs compared with MSM (AOR 1.67, 95% CI 1.43, 1.95), patients aged ≥50 years compared with the youngest group (AOR 1.62, 95% CI 1.22, 2.16) and among Blacks compared with Whites (AOR 1.43, 95% CI 1.20, 1.69). Patients with public coverage and those who were uninsured had higher
odds than those covered by private insurance. In multivariate analysis, the odds of bacteraemia were not significantly associated with receipt of HAART. The unadjusted association of HAART with any episode of bacteraemia was, however, significant (AOR 1.18, 95% CI 1.06, 1.32). The difference arises from the association between HAART, CD4 cell count and HIV-1 RNA. Adjusting for CD4 cell count and HIV-1 RNA is sufficient to reduce the HAART effect (AOR 0.95, 95% CI 0.83, 1.07; data not shown). HAART can result in changes in CD4 and HIV-1 RNA; these variables thus can be considered to be on the causal pathway through which HAART affects bacteraemia, and adjusting for such ‘downstream’ selleck chemicals llc variables will
reduce the direct effect of a causally prior variable. This study has several important findings. First, in the current Endonuclease HAART era the rate of bacteraemia in HIV-infected patients remains significantly higher than that of the general population [9,15,16]. In addition, the adjusted odds of bacteraemia appear to be increasing in recent years. Several modifiable factors appear to be protective against development of bacteraemia, including use of HAART, high CD4 cell count and not using injection drugs. The overall incidence of bacteraemia from 2000 to 2008 in this sample was 13.8 per 1000 PY. Tumbarello et al. reported a bacteraemia incidence rate of 62/1000 PY and Meynard et al. reported an incidence of 55/1000 HIV hospitalizations, both in 1998 [5,8]. While our estimates are lower, these studies were both restricted to hospitalized patients at one clinic site in Europe during the early HAART era, and may not be applicable to HIV-infected patients living in the USA in the current HAART era. Our incidence rate estimates are lower than the estimates in these prior studies, as we included all patients, regardless of hospitalization, in the denominator. Incidence fluctuated over this time period, decreasing from 2000 to 2002, and then rising from 2003 to 2007. It is not clear what produced this nonlinear pattern. Another study examining the incidence of S.