title: Incidence of pneumococcal and varicella disease in HIV-infected children and adolescents in the United Kingdom and Ireland, 1996-2011.
abstract: BACKGROUND
  To define the burden of hospitalization due to 2 vaccine-preventable infections, invasive pneumococcal disease (IPD) and varicella zoster (VZ), among HIV-infected children in the UK and Ireland.
  
  
  METHODS
  Analysis of hospitalizations of HIV-infected children <18 years receiving pediatric care and reported to the Collaborative HIV Paediatric Study (CHIPS) between 1996 and 2011.
  
  
  RESULTS
  Admissions for IPD and VZ combined accounted for ~5% of all hospital admissions for HIV-infected children each year. When compared with background rates for healthy children, the admission rate ratio for HIV-infected children on combination antiretroviral therapy (cART) was 16.7, 14.8 and 126.7 for IPD, varicella and herpes zoster, respectively, and 156.7, 86.1 and 470, respectively, for HIV-infected children not on cART. Those admitted with IPD or VZ were more likely to have Centers for Disease Control stage B/C at presentation with HIV than those without such admissions (36.8% for IPD, 29.7% for VZ and 22.1% for no IPD or VZ, P = 0.006), and were more likely to subsequently commence cART (94.7%, 91.3% and 80.2% respectively, P = 0.004).
  
  
  CONCLUSIONS
  There is a clear increased risk of admission with IPD or VZ in HIV-infected compared with uninfected children, magnified in those who have not yet commenced cART. It is anticipated that the introduction of new guidelines will result in improved vaccine uptake and thereby reduce the burden of IPD and VZ disease. Subsequent evaluation will assess the impact of these guidelines.
authors.affiliation: From the *Pediatric Infectious Diseases Unit, St Georges Healthcare NHS Trust, London, United Kingdom; †Medical Research Council Clinical Trials Unit at UCL, London, United Kingdom; ‡Clinical Sciences and Vaccine Institute, St Georges, University of London, London, United Kingdom; and §Public Health England, Colindale, London, United Kingdom.
authors.forename: Helen
authors.initials: H
authors.lastname: Payne
authors.forename: Ali
authors.initials: A
authors.lastname: Judd
authors.forename: Katherine
authors.initials: K
authors.lastname: Donegan
authors.forename: Ifeanyichukwu O
authors.initials: IO
authors.lastname: Okike
authors.forename: Shamez N
authors.initials: SN
authors.lastname: Ladhani
authors.forename: Katja
authors.initials: K
authors.lastname: Doerholt
authors.forename: Paul T
authors.initials: PT
authors.lastname: Heath
mesh_terms: D000293:Adolescent; D002644:Chickenpox / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007494:Ireland / Q000453:epidemiology; D008297:Male; D011008:Pneumococcal Infections / Q000453:epidemiology*; D006113:United Kingdom / Q000453:epidemiology