title: Risk factors for invasive pneumococcal disease in HIV-infected adults in France in the highly active antiretroviral therapy era.
abstract: Invasive pneumococcal diseases remain frequent and severe in HIV-infected subjects. To identify opportunities for prevention, we assessed risk factors of invasive pneumococcal diseases (IPD) in HIV-infected patients over a 10-year period in France. We performed a retrospective case-control study in a reference centre of HIV management in Paris. All HIV-infected patients having suffered from IPD between 2000 and 2011 were included. Control subjects were HIV-infected with no history of IPD or pneumonia, matched by date of diagnosis of HIV with controls. Two controls were randomly selected for each subject. In all, 42 HIV-infected patients presented 44 IPD episodes during the study period and were compared to 84 controls. In the multivariate analysis, patients with IPD were more likely than controls to have a Charlson Comorbidity Index ≥2 (adjusted OR = 7.07, 95% CI 1.99-25.1, p = 0.003), CD4-cell count <200/cells/µL (aOR = 6.93, 95% CI 1.80-26.7, p = 0.005), HIV-RNA viral load >400 copies/mL (aOR = 5.56, 95% CI 1.58-19.5, p = 0.007) and a non-European origin (aOR = 4.26, 95% CI 1.02-17.9, p = 0.047). HIV-infected patients with a higher burden of comorbidities, uncontrolled HIV replication, low CD4-cell counts and/or of non-European origin are at higher risk of developing IPD. Better screening for and management of HIV infection is necessary to reduce the risk of IPD.
authors.affiliation: Infectious Diseases Department, St Louis Hospital, APHP and University Paris Diderot, Paris, France annelise.munier@gmail.com.
authors.forename: Anne-Lise
authors.initials: AL
authors.lastname: Munier
authors.affiliation: Infectious Diseases Department, St Louis Hospital, APHP and University Paris Diderot, Paris, France.
authors.forename: Victoire
authors.initials: V
authors.lastname: de Lastours
authors.affiliation: Department of Biostatistics, St Louis Hospital, APHP, Paris, France.
authors.forename: Raphaël
authors.initials: R
authors.lastname: Porcher
authors.affiliation: Microbiology Department, St Louis Hospital, APHP, Paris, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Donay
authors.affiliation: Microbiology Department, St Louis Hospital, APHP, Paris, France.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Pons
authors.affiliation: Infectious Diseases Department, St Louis Hospital, APHP and University Paris Diderot, Paris, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Molina
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology*; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D005260:Female; D005602:France; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011008:Pneumococcal Infections / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000276:immunology; D012189:Retrospective Studies; D012307:Risk Factors; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D019562:Viral Load
chemical_list: D022242:Pneumococcal Vaccines
keywords: AIDS; HIV; Streptococcus pneumoniae; opportunistic infections; pneumococcal disease; risk factors