The persisting burden of invasive pneumococcal disease in HIV patients: an observational cohort study
<p>Abstract</p> <p>Background</p> <p>The increasing use of highly active antiretroviral therapy (HAART) and pneumococcal immunization along with shifting community exposures may have altered the burden of <it>Streptococcus pneumoniae </it>disease in HIV-infe...
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| Format: | Article |
| Language: | English |
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BMC
2011-11-01
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| Series: | BMC Infectious Diseases |
| Online Access: | http://www.biomedcentral.com/1471-2334/11/314 |
| _version_ | 1811245804755615744 |
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| author | Siemieniuk Reed AC Gregson Dan B Gill M John |
| author_facet | Siemieniuk Reed AC Gregson Dan B Gill M John |
| author_sort | Siemieniuk Reed AC |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>The increasing use of highly active antiretroviral therapy (HAART) and pneumococcal immunization along with shifting community exposures may have altered the burden of <it>Streptococcus pneumoniae </it>disease in HIV-infected persons. We describe the burden and risk factors for pneumococcal disease in the modern era of HIV care and evaluate the use of a 23-valent pneumococcal polysaccharide vaccine (PPV-23).</p> <p>Methods</p> <p>The incidence of invasive pneumococcal disease (IPD) between January 1<sup>st</sup>, 2000 and January 1<sup>st</sup>, 2010 in a regional HIV population in Southern Alberta, Canada was determined by linking comprehensive laboratory and hospital surveillance data. Clinical and epidemiologic data including risk factors for <it>S. pneumoniae</it>, history of pneumococcal immunization, serotypes of infections, and length of any hospitalizations for pneumococcal disease were evaluated with multivariate analysis. CD4 count and viral load at immunization were evaluated with a nested case-control analysis.</p> <p>Results</p> <p>In 1946 HIV-patients with 11,099 person-years of follow up, there were 68 distinct episodes of pneumococcal disease occurring in 50 patients. Increased risk was seen if female, age >60, Aboriginal ethnicity, lower education, injection drug use, smoking, nadir CD4 <200/μL, chronic obstructive pulmonary disease, and hepatitis C. Overall, the incidence of IPD was 342/100,000 person-years and was reduced to 187/100,000 within three years of PPV-23 immunization (P < 0.01). Although 78% of patients received PPV-23, 74% of IPD episodes were caused by PPV-23 serotypes. In a case-control analysis, HIV viral load at immunization was significantly predictive of PPV-23 failure, while CD4 count was not. 80% of IPD cases required hospitalization: median length of stay was 7 days (range: 1-71); four patients died.</p> <p>Conclusions</p> <p>Despite universal access to intensive measures to prevent pneumococcal disease including the widespread use of HAART and PPV-23 immunization, the incidence of IPD remains high in HIV patients with its associated morbidity and mortality.</p> |
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| format | Article |
| id | doaj.art-c0f1ddf27c664b4087d0eab309c0bf0b |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-04-12T14:44:40Z |
| publishDate | 2011-11-01 |
| publisher | BMC |
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| series | BMC Infectious Diseases |
| spelling | doaj.art-c0f1ddf27c664b4087d0eab309c0bf0b2022-12-22T03:28:42ZengBMCBMC Infectious Diseases1471-23342011-11-0111131410.1186/1471-2334-11-314The persisting burden of invasive pneumococcal disease in HIV patients: an observational cohort studySiemieniuk Reed ACGregson Dan BGill M John<p>Abstract</p> <p>Background</p> <p>The increasing use of highly active antiretroviral therapy (HAART) and pneumococcal immunization along with shifting community exposures may have altered the burden of <it>Streptococcus pneumoniae </it>disease in HIV-infected persons. We describe the burden and risk factors for pneumococcal disease in the modern era of HIV care and evaluate the use of a 23-valent pneumococcal polysaccharide vaccine (PPV-23).</p> <p>Methods</p> <p>The incidence of invasive pneumococcal disease (IPD) between January 1<sup>st</sup>, 2000 and January 1<sup>st</sup>, 2010 in a regional HIV population in Southern Alberta, Canada was determined by linking comprehensive laboratory and hospital surveillance data. Clinical and epidemiologic data including risk factors for <it>S. pneumoniae</it>, history of pneumococcal immunization, serotypes of infections, and length of any hospitalizations for pneumococcal disease were evaluated with multivariate analysis. CD4 count and viral load at immunization were evaluated with a nested case-control analysis.</p> <p>Results</p> <p>In 1946 HIV-patients with 11,099 person-years of follow up, there were 68 distinct episodes of pneumococcal disease occurring in 50 patients. Increased risk was seen if female, age >60, Aboriginal ethnicity, lower education, injection drug use, smoking, nadir CD4 <200/μL, chronic obstructive pulmonary disease, and hepatitis C. Overall, the incidence of IPD was 342/100,000 person-years and was reduced to 187/100,000 within three years of PPV-23 immunization (P < 0.01). Although 78% of patients received PPV-23, 74% of IPD episodes were caused by PPV-23 serotypes. In a case-control analysis, HIV viral load at immunization was significantly predictive of PPV-23 failure, while CD4 count was not. 80% of IPD cases required hospitalization: median length of stay was 7 days (range: 1-71); four patients died.</p> <p>Conclusions</p> <p>Despite universal access to intensive measures to prevent pneumococcal disease including the widespread use of HAART and PPV-23 immunization, the incidence of IPD remains high in HIV patients with its associated morbidity and mortality.</p>http://www.biomedcentral.com/1471-2334/11/314 |
| spellingShingle | Siemieniuk Reed AC Gregson Dan B Gill M John The persisting burden of invasive pneumococcal disease in HIV patients: an observational cohort study BMC Infectious Diseases |
| title | The persisting burden of invasive pneumococcal disease in HIV patients: an observational cohort study |
| title_full | The persisting burden of invasive pneumococcal disease in HIV patients: an observational cohort study |
| title_fullStr | The persisting burden of invasive pneumococcal disease in HIV patients: an observational cohort study |
| title_full_unstemmed | The persisting burden of invasive pneumococcal disease in HIV patients: an observational cohort study |
| title_short | The persisting burden of invasive pneumococcal disease in HIV patients: an observational cohort study |
| title_sort | persisting burden of invasive pneumococcal disease in hiv patients an observational cohort study |
| url | http://www.biomedcentral.com/1471-2334/11/314 |
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