People with HIV less likely to receive inappropriate antibiotics, study finds
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People living with HIV were less likely to receive inappropriate antibiotics for acute respiratory infections compared with people without HIV, especially when treated by an HIV clinician, researchers found.
Infectious diseases fellow Mackenzie R. Keintz, MD, and colleagues at the University of Nebraska Medical Center hypothesized that people with HIV would be more likely to receive inappropriate antibiotics for an acute respiratory infection because they are assumed to be at higher risk.
“People with HIV have often been excluded from studies evaluating overuse of antimicrobials,” Keintz told Healio. “This population is particularly susceptible to overuse as clinicians may regard HIV automatically as a disease state of increased infection risk regardless of immunologic control or virologic suppression.”
Keintz and colleagues conducted an observational study to determine if people with HIV received a disproportionate number of antimicrobials when under evaluation for acute upper respiratory infections compared with other patients.
They enrolled 209 patients with HIV in the study and 398 in a non-HIV cohort. The patients received care in the hospital’s outpatient clinical practices between Jan. 1, 2014, and April 30, 2018.
Overall, 37% of visits resulted in an antibiotic prescription, with 89% being considered inappropriate, Keintz and colleagues found. Antibiotics were prescribed more frequently for patients without HIV (40% vs. 35%; P = .172), and were concordant with guidelines more often when they were prescribed for patients with HIV (37% vs. 30%; P = .039).
Antibiotics also were more likely to be appropriately prescribed to patients with HIV who were managed by HIV clinicians compared with non-HIV clinicians (29% vs. 12%; P = .010).
“Despite many [people with HIV] frequently having virological suppression and immunologic control, they are still subject to overexposure to antimicrobial use in acute upper respiratory infections when antibiotic therapy may not be indicated,” Keintz said. “The inclusion of HIV clinicians in care can help to decrease the inappropriate use of antibiotics and decrease the duration of antibiotics when indicated.”
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