Invasive pneumococcal disease among HIV-positive individuals, 2000-2009.
OBJECTIVE
To examine invasive pneumococcal disease (IPD) incidence, the impact of the 7-valent pneumococcal conjugate vaccines (PCV7s) programme on the distribution of Streptococcus pneumoniae serotypes and risk factors for IPD among HIV-positive adults.


METHODS
We analysed adults (aged ≥15 years) reported to the HIV and IPD national datasets in England and Wales (2000-2009). Through data-linkage, changes in IPD incidence and serotype distribution were examined. Risk factors for IPD among HIV-positive adults were assessed using a case-control study.


RESULTS
Among 63,109 HIV-positive adults, 951 were co-infected with IPD. The average annual incidence of IPD was 245 episodes per 100,000 HIV-positive adults and 246 of 100,000 among those aged 15-44 years. Incidence was higher among those not on antiretroviral therapy (ART) (281 of 100,000) and those with severe immunosuppression (563 of 100,000). Among 9283 adults aged 15-44 at IPD diagnosis, 2.4% were living with undiagnosed HIV. The proportion of IPD episodes in HIV-positive adults with serotypes covered by PCV7 was 23% in 2009, a 54% proportional reduction compared with pre-PCV7 (2000-2006); the reduction in adults of unknown HIV status was 70%. The proportion of IPD episodes among HIV-positive adults caused by serotypes covered by PCV13 was 61%. Significant risk factors for IPD in multivariate analysis included older aged (≥65 years), a lower nadir CD4 cell count and no previous ART.


CONCLUSIONS
An HIV test should be offered and recommended to adults aged 15-44 years without other obvious IPD risk factors. Our study provides an evidence base to policy makers regarding the use of the new PCV13 in HIV-positive adults.
HIVand STI Department, Health Protection Agency, London, UK. zheng.yin@hpa.org.uk
Zheng
Z
Yin
Brian D
BD
Rice
Pauline
P
Waight
Elizabeth
E
Miller
Robert
R
George
Alison E
AE
Brown
Ruth D
RD
Smith
Mary
M
Slack
Valerie C
VC
Delpech
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology / Q000382:microbiology*; D000293:Adolescent; D000328:Adult; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D004739:England / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology; D006801:Humans; D015994:Incidence; D008297:Male; D008498:Medical Record Linkage; D011008:Pneumococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology / Q000382:microbiology; D022242:Pneumococcal Vaccines / Q000008:administration & dosage* / Q000276:immunology*; D012307:Risk Factors; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000276:immunology / Q000472:pathogenicity; D013997:Time Factors; D014852:Wales / Q000453:epidemiology; D055815:Young Adult
D022242:Pneumococcal Vaccines