Prior antimicrobial prescription frequency a harbinger for HIV diagnosis

  • Martin-Iguacel R & al.
  • Euro Surveill
  • 1 Oct 2019

  • International Clinical Digest
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Takeaway

  • Danish study findings show that frequent primary healthcare visits and high antimicrobial drug consumption are linked to subsequent HIV diagnosis (within 3 years), especially among men presenting with late-stage HIV.

Why this matters

  • Consider HIV testing in patients, especially men, with increasingly frequent provider visits, prescriptions for sexually transmitted infections, or viral/fungal infections.

Key results

  • 2784 cases, 36,192 controls.
  • 72.4% cases, 46.3% controls had >1 antimicrobial drug prescription (P<.001>
  • HIV diagnosis risk increased with >1 treatment: beta-lactams (OR, 2.13; 95% CI, 1.97-2.30), macrolides (OR, 3.12; 95% CI, 2.87-3.40), acyclovir (OR, 7.20; 95% CI, 6.29-8.25), azoles (OR, 3.25; 95% CI, 2.84-3.72), quinolones (OR, 4.14; 95% CI, 3.52-4.81), nystatin (OR, 10.55; 95% CI, 8.27-13.46), doxycycline (OR, 4.61; 95% CI, 3.77-5.65), urinary tract infection drugs (OR, 1.80; 95% CI, 1.54-2.09).
  • The association appeared higher for men vs women, with more pronounced association observed for cases presenting with late-stage HIV (P<.01 likelihood ratio test for beta-lactams macrolides acyclovir azoles nystatin only>

Study design

  • Nested, case-control study assessing antimicrobial drug prescriptions 3 years pre-HIV diagnosis and predictive risk value of antimicrobial consumption among Danish patients, 1998-2016.
  • Funding: University of Southern Denmark, Danish AIDS-foundation.

Limitations

  • Misclassification errors.
  • Limited generalisability.