title: Antiretroviral Therapy as Prevention of … Pneumococcal Infections?
abstract: BACKGROUND
  Despite antiretroviral therapy, it is generally believed that the risk for pneumococcal infections (PnIs) is high among patients infected with human immunodeficiency virus (HIV). However, most studies in this field have been conducted before 2010, and the proportion of virologically suppressed patients has drastically increased in these latter years thanks to larger indications and more effective antiretroviral regimens. This study aimed to re-evaluate the current risk of PnI among adult patients infected with HIV.
  
  
  METHODS
  The incidence of PnI was evaluated between 1996 and 2014 in 2 French regional hospitals. The 80 most recent cases of PnI (2000-2014) were retrospectively compared with 160 controls (HIV patients without PnI) to analyze the residual risk factors of PnI.
  
  
  RESULTS
  Among a mean annual follow-up cohort of 1616 patients, 116 PnIs were observed over 18 years. The risk factors of PnI among patients infected with HIV were an uncontrolled HIV infection or "classic" risk factors of PnI shared by the general population such as addiction, renal or respiratory insufficiency, or hepatitis B or C coinfection. Pneumococcal vaccination coverage was low and poorly targeted, because only 5% of the cases had been previously vaccinated. The incidence of invasive PnIs among HIV patients with a nonvirologically suppressed infection or comorbidities was 12 times higher than that reported in the general population at the country level (107 vs 9/100000 patients), whereas the incidence among virologically suppressed HIV patients without comorbidities was lower (7.6/100000 patients).
  
  
  CONCLUSIONS
  Human immunodeficiency virus infection no longer per se seems to be a significant risk factor for PnI, suggesting a step-down from a systematic to an "at-risk patient" targeted pneumococcal vaccination strategy.
authors.affiliation: Centre Hospitalo-Universitaire Charles Nicolle, Service de Maladies Infectieuses et Tropicales , Rouen, France.
authors.forename: Anaïs
authors.initials: A
authors.lastname: Lesourd
authors.affiliation: Centre Hospitalo-Universitaire Charles Nicolle, Service de Maladies Infectieuses et Tropicales , Rouen, France.
authors.forename: Jérémie
authors.initials: J
authors.lastname: Leporrier
authors.affiliation: Centre Hospitalo-Universitaire Charles Nicolle, Service de Maladies Infectieuses et Tropicales, Rouen, France;; Groupe de Recherche sur l'Adaptation Microbienne (2.0-EA 2656, Institut de Recherche et d'Innovation Biomédicale), Normandie Université, Rouen, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Delbos
authors.affiliation: Centre Hospitalo-Universitaire Charles Nicolle, Service de Maladies Infectieuses et Tropicales, Rouen, France;; Groupe de Recherche sur l'Adaptation Microbienne (2.0-EA 2656, Institut de Recherche et d'Innovation Biomédicale), Normandie Université, Rouen, France.
authors.forename: Guillemette
authors.initials: G
authors.lastname: Unal
authors.affiliation: Centre Hospitalo-Universitaire Avicenne, Service de Maladies Infectieuses et Tropicales , Bobigny, France.
authors.forename: Patricia
authors.initials: P
authors.lastname: Honoré
authors.affiliation: Centre Hospitalo-Universitaire Charles Nicolle, Service de Maladies Infectieuses et Tropicales, Rouen, France;; Groupe de Recherche sur l'Adaptation Microbienne (2.0-EA 2656, Institut de Recherche et d'Innovation Biomédicale), Normandie Université, Rouen, France.
authors.forename: Manuel
authors.initials: M
authors.lastname: Etienne
authors.affiliation: Centre Hospitalo-Universitaire Avicenne, Service de Maladies Infectieuses et Tropicales , Bobigny, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Bouchaud
authors.affiliation: Centre Hospitalo-Universitaire Charles Nicolle, Service de Maladies Infectieuses et Tropicales, Rouen, France;; Groupe de Recherche sur l'Adaptation Microbienne (2.0-EA 2656, Institut de Recherche et d'Innovation Biomédicale), Normandie Université, Rouen, France.
authors.forename: François
authors.initials: F
authors.lastname: Caron
keywords: HIV; Streptococcus pneumoniae; pneumococcal infections; risk factors; vaccination