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Open Access Research article

Increased risk of deep neck infection among HIV-infected patients in the era of highly active antiretroviral therapy—a population-based follow-up study

Ching-Feng Liu12, Shih-Feng Weng34, Yung-Song Lin1, Chih-Sheng Lin2, Ching-Feng Lien1* and Jhi-Joung Wang3

Author Affiliations

1 Department of Otolaryngology, Chi Mei Medical Center, Tainan, Taiwan

2 Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan

3 Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan

4 Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan

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BMC Infectious Diseases 2013, 13:183  doi:10.1186/1471-2334-13-183

Published: 22 April 2013



Deep neck infections (DNIs) in HIV-infected patients often produce severe complications, even death. Data on the incidence rates and risks of DNI among HIV-infected patients are scarce, particularly with the widespread use of highly active antiretroviral therapy (HAART). We evaluated the incidence rates and risks for DNI among HIV-infected patients and observed the long-term trends.


A total of 9888 new HIV-infected patients diagnosed in 2001–2007 were included and matched with 49440 randomly selected subjects. The HIV-infected subjects were offered free access to HAART. All subjects were traced until December 2009. A Kaplan-Meier analysis generated the cumulative DNI incidence rate. The adjusted hazard ratio was computed using Cox proportional hazard regressions.


From the HIV-infected and comparison cohorts, 222 individuals (57.01 cases per 10000 person-years) and 735 individuals (35.54 cases per 10000 person-years) developed DNI, respectively. The log rank test indicated that patients with HIV had a significantly higher 8-year incidence rate of DNI than the control group (P < 0.0001). The adjusted hazard ratio for developing DNI after an HIV attack during the mean 3.94 years follow-up period was 1.59. The incidence rate and relative risk of DNI were 74.58 (per 10000 person-years) and 2.05 (P < 0.0001). Both figures were highest in the first follow-up year and decreased year-by-year thereafter.


The risk of developing DNI is significantly elevated among HIV-infected patients, even with free access to HAART. Additional research is needed to examine the role of HAART in reducing the risk.

Deep neck infection; HIV; Highly active antiretroviral therapy