Invasive pneumococcal disease in patients infected with HIV: still a threat in the era of highly active antiretroviral therapy.
We studied all human immunodeficiency virus (HIV)-infected patients with invasive pneumococcal disease who received their diagnosis during 1996-2002 to investigate the incidence of this disease in the highly active antiretroviral therapy era and to study the influence of CD4 lymphocyte count on the clinical presentation and outcome of disease. The overall incidence of invasive pneumococcal disease was 11.3 cases per 100,000 person-years in adult patients without known HIV infection and 677 cases per 100,000 person-years in HIV-infected patients. This incidence remained stable over the study period. Clinical presentation, severity of illness, and number of recurrent episodes were similar in patients with CD4+ cell counts of >200 or < or =200 cells/ microL. Patients receiving trimethoprim-sulfamethoxazole (TMP-SMZ) were more likely to present with TMP-SMZ-resistant pneumococci than were those who were not receiving this agent (76.7% vs. 43.6%; P=.007). The mortality rate was high (21%).
Jordano
Queralt
Q
Infectious Disease Division, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Falcó
Vicenç
V
Almirante
Benito
B
Planes
Ana María
AM
del Valle
Oscar
O
Ribera
Esteve
E
Len
Oscar
O
Pigrau
Carles
C
Pahissa
Albert
A
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology / Q000401:mortality; D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology / Q000401:mortality; D000328:Adult; D000818:Animals; D023241:Antiretroviral Therapy, Highly Active; D015897:Comorbidity; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006678:HIV / Q000302:isolation & purification*; D015658:HIV Infections / Q000453:epidemiology* / Q000401:mortality*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D011008:Pneumococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality*; D045363:Pneumocystis carinii / Q000302:isolation & purification; D011020:Pneumonia, Pneumocystis / Q000453:epidemiology / Q000401:mortality; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000302:isolation & purification; D014122:Toxoplasma / Q000302:isolation & purification; D016781:Toxoplasmosis, Cerebral / Q000453:epidemiology / Q000401:mortality; D014296:Trimethoprim Resistance; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000378:metabolism / Q000627:therapeutic use
D015662:Trimethoprim, Sulfamethoxazole Drug Combination