LAUSR

Inappropriate antibiotic use in acute respiratory infections (ARIs) is a major public health concern, however data for people living with HIV (PLHIV) are limited. The HIV Virtual Cohort Study is a retrospective cohort of adult Department of Defense beneficiaries. Male PLHIV cases (n=2,413) were matched 1:2 to controls without HIV (n=4,826) by age, gender, race/ethnicity, and beneficiary status. ARI encounters between 2016-2020 and corresponding antibiotic prescriptions were characterized as always, sometimes, or never appropriate based on ICD-10 coding. Incidence of ARI encounters and antibiotic appropriateness were compared between PLHIV and controls. Subgroup analyses were assessed by CD4 count and viral load suppression on antiretroviral therapy (ART). Mean rates of ARI encounters were similar for PLHIV (1,066 per 1,000 person-years) and controls (1,010 per 1,000 person-years), however the rate was double among PLHIV without VL suppression (2,018 per 1,000 person-years). Antibiotics were prescribed in 26% of encounters among PLHIV compared to 34% for controls (p=<0.01); antibiotic use was “never” appropriate in 38% of encounters with PLHIV and 36% in controls. Compared to controls, PLHIV received more sulfonamides (5.5% vs 2.7%; p=0.001), and variation existed among HIV-subgroups in the prescription of sulfonamides, fluoroquinolones, and beta-lactams. ARI encounters were similar for PLHIV and those without HIV, however, PLHIV with lower CD4 counts and/or non-suppressed VL had more frequent ARI visits. Inappropriate antibiotic use for ARIs was high in both populations and focused interventions to improve antibiotic appropriateness for prescribers caring for PLHIV should be pursued.