Pneumococcal disease among human immunodeficiency virus-infected persons: incidence, risk factors, and impact of vaccination.
To determine the factors associated with pneumococcal disease (pneumococcal pneumonia or invasive disease) and the impact of pneumococcal vaccine in HIV-infected persons, we analyzed patient data collected by the Adult and Adolescent Spectrum of HIV Disease Project for person-time between January 1990 and December 1998. Among 39,086 persons with 71,116 person-years (py) of observation, 585 episodes of pneumococcal disease were diagnosed (incidence, 8.2 episodes per 1000 py). Factors associated with an increased risk for pneumococcal disease (P < .05) included injection drug use (adjusted relative risk [RR], 1.5) and blood transfusion (RR, 2.0) as the mode of HIV transmission (referent, male-male sex); black race/ethnicity (RR, 1.5; referent, white race); history of acquired immunodeficiency syndrome (AIDS)-defining opportunistic illness (RR, 2.1); a CD4(+) cell count of 200-499 cells/microL (RR, 2.5) or < 200 cells/microL (RR, 3.7; referent, CD4(+) cell count of > or = 500 cells/microL); and alcoholism (RR, 2.0). Factors associated with a decreased risk included prescription of antiretroviral therapy (RR for monotherapy, 0.6; for dual therapy, 0.7; for triple therapy, 0.5) and pneumococcal vaccination (RR for persons vaccinated at a CD4(+) cell count of > or = 500 cells/microL, 0.5). We recommend that pneumococcal vaccine be given to HIV-infected persons before profound immunosuppression has occurred.
Division of HIV/AIDS Prevention-Surveillance and Epidemiology, National Center for HIV, STD, and TB Prevention, Atlanta, GA, 30333, USA. mdworkin@idph.state.il.us
M S
MS
Dworkin
J W
JW
Ward
D L
DL
Hanson
J L
JL
Jones
J E
JE
Kaplan
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D022242:Pneumococcal Vaccines; D012189:Retrospective Studies; D012307:Risk Factors; D013296:Streptococcus pneumoniae / Q000276:immunology; D014611:Vaccination
D022242:Pneumococcal Vaccines