title: Invasive pneumococcal disease in HIV-infected adults: clinical changes after the introduction of the pneumococcal conjugate vaccine in children.
abstract: BACKGROUND
  Few data exist on the implications of widespread use of 7-valent pneumococcal conjugate vaccine in children in the invasive pneumococcal disease (IPD) in HIV-infected adults. We conducted a multicenter study to analyze differences in clinical presentation of IPD between HIV-infected and non-HIV-infected adults in the prevaccine and postvaccine era.
  
  
  METHODS
  Study of all cases of IPD in HIV-infected adults diagnosed since 1996 to 2010. Episodes were classified into prevaccine (1996-2001), early postvaccine (2002-2004), and late postvaccine period (2005-2010). For each case, we identified an HIV-negative control patient with IPD matched by hospital, age, and vaccine period.
  
  
  RESULTS
  Two hundred twenty-one episodes of IPD in HIV-infected patients were diagnosed. The incidence of IPD decreased from 7.81 to 3.69 episodes per 1000 patient-years (-53%; 95% confidence interval: -65% to -36%, P < 0.001) between prevaccine and late postvaccine period. There was an 81% (95% confidence interval: -88% to -69%, P < 0.001) decrease of IPD caused by vaccine serotypes. In late postvaccine period IPD in HIV-infected patients was associated to higher rates of respiratory failure (28.4% vs. 48.4%, P = 0.011), greater intensive care unit admission (8.2% vs. 21.7%, P = 0.02) and a higher need for mechanical ventilation (5.9% vs. 16.3%, P = 0.033). In the prevaccine period, non-HIV-infected patients had a more severe illness than in those with HIV infection; however, these differences disappeared in the late postvaccine period.
  
  
  CONCLUSIONS
  In the late postvaccine era, the incidence of IPD in HIV-infected patients has decreased, however, clinical presentation seems to have changed to a more severe illness. The widespread use of highly active antiretroviral therapy, polyssacharide vaccine, and 7-valent pneumococcal conjugate vaccine has contributed to these changes.
authors.affiliation: Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.
authors.forename: Joaquin
authors.initials: J
authors.lastname: Burgos
authors.forename: Maria
authors.initials: M
authors.lastname: Peñaranda
authors.forename: Antoni
authors.initials: A
authors.lastname: Payeras
authors.forename: Aroa
authors.initials: A
authors.lastname: Villoslada
authors.forename: Adrian
authors.initials: A
authors.lastname: Curran
authors.forename: Margarita
authors.initials: M
authors.lastname: Garau
authors.forename: Melcior
authors.initials: M
authors.lastname: Riera
authors.forename: Manuel
authors.initials: M
authors.lastname: Crespo
authors.forename: Jordi
authors.initials: J
authors.lastname: Navarro
authors.forename: Eva
authors.initials: E
authors.lastname: Van den Eynde
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Planes
authors.forename: Esteban
authors.initials: E
authors.lastname: Ribera
authors.forename: Albert
authors.initials: A
authors.lastname: Pahissa
authors.forename: Vicenç
authors.initials: V
authors.lastname: Falcó
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016022:Case-Control Studies; D024881:Drug Resistance, Bacterial; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000150:complications* / Q000453:epidemiology; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D012307:Risk Factors; D013296:Streptococcus pneumoniae / Q000187:drug effects; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D022242:Pneumococcal Vaccines