However, our design is similar to those of the two other contemporary studies that report rates of SAB among HIV-infected individuals [5,24]. We do not have information on the use of prophylaxis for Pneumocystis jirovecii and atypical mycobacterial disease or the treatment of tuberculosis. Antimicrobials with activity against P. jirovecii and mycobacteria have antibacterial activity and have been shown to reduce rates of invasive bacterial disease [33–35]. Use of such drugs would lead to an underestimation of IRs in individuals with low CD4 cell counts. However, just 6% of the observation time was accounted for by HIV-infected individuals with CD4 counts

<100 cells/μL. Surveillance bias may have led to an overestimation

of IRs among HIV-infected individuals because learn more physicians are likely to have a lower threshold for hospital admission and work-up of HIV-infected individuals, who have closer health care contact than the general population. PD-166866 order If an individual was identified in the DHCS they were considered to be infected with HIV. If an individual was not present in the DHCS, they were considered to be HIV uninfected. This is not necessarily a safe assumption, as it is estimated that 1000 individuals are infected but not yet diagnosed with HIV and thus unaware of their infection. This number has been reached using back calculation for the period up to 1995, and for the period from 1996 onwards based on the assumption of a constant HIV incidence in Denmark [36]. In addition to regular HIV testing of IDUs, HIV testing could prove beneficial in younger adults who are not IDUs and who present with CA SAB. We found that the incidence of SAB in HIV-infected individuals declined during 4��8C the study period, but remained higher than that in HIV-uninfected individuals. The burden of SAB was disparately distributed among groups

of HIV-infected individuals so that IDUs had a 20-fold higher IR of SAB compared with MSM in the late time period (2003-2007). Immunodeficiency was the strongest predictor of SAB among HIV-infected individuals, although the underlying mechanisms are likely to differ among HIV transmission groups. IDU, nonsuppressed HIV RNA and lack of HAART also predicted SAB. The authors thank the staff at the participating clinical departments and the clinical microbiological laboratories for their contributions, continuous support and enthusiasm. Centres in the Danish HIV Cohort Study are as follows: Departments of Infectious Diseases at Copenhagen University Hospitals, Rigshospitalet (J. Gerstoft and N. Obel) and Hvidovre (G. Kronborg), Odense University Hospital (C. Pedersen), Aarhus University Hospitals, Skejby (C. S. Larsen) and Aalborg (G. Pedersen), Herning Hospital (A. L. Laursen), Helsingør Hospital (L. Nielsen) and Kolding Hospital (J. Jensen). Author contributions: MVL, ZBH and TB conceived and designed the experiments.