Corticosteroids Use and Incidence of Severe Infections in People Living with HIV Compared to a Matched Population

Abstract

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.

Relevance of biomarkers indicating gut damage and microbial translocation in people living with HIV

“…GCs have also been reported to decrease LPS-induced inflammatory responses (286-288), reduce HIV viral loads, and to postpone CD4 + T-cell loss (289,290), and the progression to AIDS (291). However, these therapies remain experimental, and the utilization of GCs must be reserved for specific circumstances only and should be strictly controlled, as their use may raise multiple issues, including adverse effects (292,293) and the interactions of GCs with antiretroviral-boosting agents (e.g., ritonavir and cobicistat) that are currently included in ART regimens (294, 295). The inflammatory cytokine TNF-a has been reported to increase epithelial cell shedding and increases intestinal epithelial tight junction permeability, along with enhancing gut permeability (283, 296, 297).…”

Anti-N-methyl-d-aspartate Receptor Encephalitis in People Living with HIV: Case Report and Literature Review

“…Because of their impaired immune status, the patients' treatment response and prognosis for anti-NMDAR encephalitis in PLWH may differ from those of the general population, requiring extra caution during treatment. For PLWH, a long course of high-dose corticosteroid therapy could further inhibit impaired immunity, increasing the risk of opportunistic infections and complexity of the condition [ 19 ].…”

Longitudinal Extensive Transverse Myelitis due to Varicella‐Zoster Virus Infection in an Undiagnosed HIV‐Positive Patient

“…Although in immunocompromised patients, the initiation of corticosteroids is associated with a higher risk of opportunistic infections due to the increased risk [ 19 ], early treatment with a high dose of methylprednisolone appears to be more effective in reducing neurologic sequelae.…”