title: Invasive pneumococcal disease in a cohort of HIV-infected adults: incidence and risk factors, 1990-2003.
abstract: OBJECTIVE
  To investigate the association between the introduction of HAART and invasive pneumococcal disease (IPD) in HIV-infected patients.
  
  
  METHODS
  Incidence of IPD was determined from 1990 to 2003 in a cohort of HIV-infected individuals and a nested case-control study assessed risk factors of IPD.
  
  
  RESULTS
  There were 72 cases over 19,020 person-years of follow-up (overall IPD rate, 379/100,000 person-years). In the calendar periods 1990-1995, 1995-1998, and 1998-2003, the IPD incidence per 100,000 person-years was 279 [95% confidence interval (CI), 150-519], 377 (95% CI, 227-625) and 410 (95% CI, 308-545), respectively (P = 0.516). CD4 cell count < 200 cells/microl [odds ratio (OR), 3.0; 95% CI, 1.2-7.6), HIV RNA > 50,000 copies/ml (OR, 2.8; 95% CI, 1.2-6.5), hepatitis C (OR, 4.9; 95% CI, 1.7-14.9), serum albumin (OR, 0.1; 95% CI, 0.04-0.5), injection drug use in women (OR, 3.8; 95% CI, 1.6-8.8), and education beyond high school (OR, 0.2; 95% CI, 0.05-0.8) were significantly associated with IPD in multivariate analysis. No treatment factor, including HAART (OR, 0.7; 95% CI, 0.3-1.5) and pneumococcal vaccination (OR, 0.9; 95% CI, 0.5-1.6), was associated with IPD.
  
  
  CONCLUSIONS
  IPD incidence did not change significantly during the widespread dissemination of HAART in this cohort. IPD risk was associated with several sociodemographic and clinical factors.
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. pennanbarry@gmail.com
authors.forename: Pennan M
authors.initials: PM
authors.lastname: Barry
authors.forename: Nicola
authors.initials: N
authors.lastname: Zetola
authors.forename: Jeanne C
authors.initials: JC
authors.lastname: Keruly
authors.forename: Richard D
authors.initials: RD
authors.lastname: Moore
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Gebo
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Lucas
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D016022:Case-Control Studies; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D011008:Pneumococcal Infections / Q000453:epidemiology*; D012307:Risk Factors