Acute Infections, Antibiotic Use and Antibiotic-Related Knowledge Among People Living with HIV: A Cross-Sectional...

Background: Acute infections and antibiotic use remain clinically relevant among people living with HIV (PLWH). This exploratory study assessed self-reported acute infections, usual healthcare contact, antibiotic use, and antibiotic-related knowledge among PLWH. Methods: We conducted a single-center cross-sectional questionnaire-based study among 209 PLWH in Bucharest, Romania (October 2025-March 2026). The questionnaire assessed self-reported acute infections and hospitalizations during the preceding 12 months, usual healthcare contact, antibiotic use, and six knowledge items. Frequent self-reported antibiotic use was defined as use on at least three occasions during the preceding 12 months. Results: At least one self-reported acute infection was reported by 45.5% of participants; 9.6% reported an infection-related hospitalization. The family physician was the most frequently reported usual healthcare contact (55.0%), followed by the infectious diseases physician (31.6%). Among 207 participants with evaluable antibiotic-use data, 22 (10.6%) met the frequent-use definition. In exploratory analyses, knowledge scores were higher among participants with greater educational attainment and those living in urban areas, but showed no clear evidence of an association with frequent self-reported antibiotic use (unadjusted OR per 1-point increase, 1.16; 95% CI 0.88-1.54; p = 0.290). In an exploratory adjusted analysis, self-reported acute infection and suboptimal physician-estimated antiretroviral therapy (ART) adherence were associated with frequent self-reported antibiotic use. Conclusions: Frequent self-reported antibiotic use was associated with reported acute infections and suboptimal physician-estimated ART adherence, whereas there was no clear evidence of an association with antibiotic-related knowledge. This pattern suggests that infectious morbidity and care-related factors may be important correlates of repeated antibiotic use in PLWH and highlights the potential value of coordinated stewardship across HIV and primary care.