Epidemiologic changes in bacteremic pneumococcal disease in patients with human immunodeficiency virus in the era of highly active antiretroviral therapy.
BACKGROUND
The use of highly active antiretroviral therapy (HAART) may change the incidence of, and the risk and prognostic factors for, invasive pneumococcal disease in patients with human immunodeficiency virus (HIV).


METHODS
We prospectively studied 142 episodes of pneumococcal bacteremia in 122 HIV-infected adults. Eighty-five episodes occurred in the pre-HAART era (1986-1996) and 57 in the HAART era (1997-2002). A case-control study was conducted to identify risk factors for pneumococcal bacteremia in the HAART era.


RESULTS
The incidence of pneumococcal bacteremia dropped from 24.1 episodes per 1000 patient-years in the pre-HAART era to 8.2 episodes per 1000 patient-years in the HAART era (P = .01). Compared with patients in the pre-HAART era, patients in the HAART era had more associated comorbidity (42% vs 26%; P = .04), fewer recurrences of bacteremia (4% vs 15%; P = .04), and a higher 30-day mortality rate (26% vs 8%; P=.004). High antibiotic resistance rates were observed in both periods. By multivariate analysis, the major risk factors for pneumococcal bacteremia in the HAART era were associated comorbidity (adjusted odds ratio [OR], 3.36), alcohol abuse (adjusted OR, 5.28), prior hospitalization (adjusted OR, 3.38), current smoking (adjusted OR, 5.19), and CD4 cell count lower than 100 cells/muL (adjusted OR, 2.38); while use of HAART (adjusted OR, 0.37) and pneumococcal vaccine (adjusted OR, 0.39) were protective factors.


CONCLUSIONS
The widespread use of HAART and pneumococcal vaccine may decrease the incidence of invasive pneumococcal disease in HIV-infected patients. Risk factors and prognosis of pneumococcal bacteremia in the HAART era are more similar to those reported in non-HIV-infected individuals.
Grau
Imma
I
Infectious Disease Service, Clinical Research Unit, IDIBELL-Hospital de Bellvitge and University of Barcelona, Barcelona, Spain.
Pallares
Roman
R
Tubau
Fe
F
Schulze
Marco H
MH
Llopis
Ferran
F
Podzamczer
Daniel
D
Liñares
Josefina
J
Gudiol
Francesc
F
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000907:Antibodies, Bacterial / Q000276:immunology; D023241:Antiretroviral Therapy, Highly Active; D016470:Bacteremia / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D006678:HIV; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D016017:Odds Ratio; D011008:Pneumococcal Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013296:Streptococcus pneumoniae / Q000276:immunology / Q000302:isolation & purification; D015996:Survival Rate / Q000639:trends
D019380:Anti-HIV Agents; D000907:Antibodies, Bacterial