Incidence of bacterial respiratory infection and pneumonia in people with HIV with and without airflow limitation

We aimed to determine the incidence rate, pathogen composition, and risk factors, particularly airflow limitation, associated with bacterial respiratory infection and pneumonia in a prospective cohort of well-treated PWH between 2015-2021. We included 1007 PWH from the Copenhagen Co-morbidity in HIV infection (COCOMO) study. Spirometry was performed at inclusion. Microbiology samples were collected prospectively. Cumulative incidence was determined by the Aalen-Johansen estimator. Cox proportional hazards models were used to calculate risk factors, adjusted for traditional and HIV-specific variables. The incidence rates of first bacterial respiratory infection and pneumonia were 12.4 [95%CI 9.7-15.5] and 5.5 [95%CI: 3.8-7.7] per 1000 person-years, respectively. The cumulative incidence of pneumonia was four times higher in PWH with airflow limitation (11.8% vs. 3.2%, p