title: Increased incidence of meningococcal disease in HIV-infected individuals associated with higher case-fatality ratios in South Africa.
abstract: OBJECTIVE
  We aimed to compare the incidence of meningococcal disease amongst HIV-infected and uninfected individuals and to evaluate whether HIV is a risk factor for mortality and bacteremia amongst patients with meningococcal disease.
  
  
  METHODS
  Cohort surveillance study.
  
  
  METHODS
  We conducted laboratory-based surveillance for meningococcal disease in Gauteng Province, South Africa. HIV status and outcome data were obtained at sentinel sites. Incidence in HIV-infected and uninfected persons was calculated assuming a similar age-specific HIV prevalence in tested and untested individuals. Risk factors for death and bacteremia (as compared with meningitis) were evaluated using multivariable logistic regression.
  
  
  RESULTS
  From 2003 to 2007, 1336 meningococcal cases were reported. Of 504 patients at sentinel sites with known outcome, 308 (61%) had HIV serostatus data. HIV prevalence amongst cases of meningococcal disease was higher than the population HIV prevalence in all age groups. The incidence of meningococcal disease in HIV-infected individuals was elevated in all age groups with an age-adjusted relative risk of 11.3 [95% confidence interval (CI) 8.9-14.3, P < 0.001]. The case-fatality ratio (CFR) was 20% (27/138) amongst HIV-infected and 11% (18/170) amongst HIV-uninfected individuals [odds ratio (OR) 2.1, 95% CI 1.1-3.9]. On multivariable analysis, CFR was greater amongst patients with bacteremia (35%, 29/82) compared with meningitis (7%, 16/226) (OR 7.8, 95% CI 3.4-17.7). HIV infection was associated with increased odds of bacteremia (OR 2.7, 95% CI 1.5-5.0).
  
  
  CONCLUSIONS
  HIV-infected individuals may be at increased risk of meningococcal disease. The increased CFR in HIV-infected patients may be explained by their increased odds of bacteremia compared to meningitis.
authors.affiliation: National Institute for Communicable Diseases, Johannesburg, South Africa. cherylc@nicd.ac.za <cherylc@nicd.ac.za>
authors.forename: Cheryl
authors.initials: C
authors.lastname: Cohen
authors.forename: Elvira
authors.initials: E
authors.lastname: Singh
authors.forename: Henry M
authors.initials: HM
authors.lastname: Wu
authors.forename: Stacey
authors.initials: S
authors.lastname: Martin
authors.forename: Linda
authors.initials: L
authors.lastname: de Gouveia
authors.forename: Keith P
authors.initials: KP
authors.lastname: Klugman
authors.forename: Susan
authors.initials: S
authors.lastname: Meiring
authors.forename: Nelesh
authors.initials: N
authors.lastname: Govender
authors.forename: Anne
authors.initials: A
authors.lastname: von Gottberg
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000401:mortality; D000293:Adolescent; D000328:Adult; D016470:Bacteremia / Q000453:epidemiology / Q000401:mortality / Q000821:virology; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008585:Meningitis, Meningococcal / Q000453:epidemiology* / Q000401:mortality / Q000821:virology; D009345:Neisseria meningitidis / Q000302:isolation & purification*; D012307:Risk Factors; D018571:Sentinel Surveillance; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult