Incidence and Risk Factors for Invasive Pneumococcal Disease and Community-acquired Pneumonia in Human Immunodeficiency Virus–Infected Individuals in a High-income Setting

Abstract Background Although people living with human immunodeficiency virus (PLWH) are at increased risk of invasive pneumococcal disease (IPD) and community-acquired pneumonia (CAP), it is unclear whether this remains the case in the setting of early initiation of combination antiretroviral therap...

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Published in:	Clinical infectious diseases Vol. 71; no. 1; pp. 41 - 50
Main Authors:	Garcia Garrido, Hannah M, Mak, Anne M R, Wit, Ferdinand W N M, Wong, Gino W M, Knol, Mirjam J, Vollaard, Albert, Tanck, Michael W T, Van Der Ende, Arie, Grobusch, Martin P, Goorhuis, Abraham
Format:	Journal Article
Language:	English
Published:	US Oxford University Press 24-06-2020
Subjects:	Aged and Commentaries Case-Control Studies Europe HIV HIV Infections - complications HIV Infections - epidemiology Humans Incidence Pneumococcal Infections - complications Pneumococcal Infections - epidemiology Pneumococcal Infections - prevention & control Pneumococcal Vaccines Pneumonia Pneumonia, Pneumococcal - complications Pneumonia, Pneumococcal - epidemiology Pneumonia, Pneumococcal - prevention & control Risk Factors Europe epidemiology HIV community-acquired pneumonia pneumococcal disease vaccination
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Summary:	Abstract Background Although people living with human immunodeficiency virus (PLWH) are at increased risk of invasive pneumococcal disease (IPD) and community-acquired pneumonia (CAP), it is unclear whether this remains the case in the setting of early initiation of combination antiretroviral therapy (cART), at high CD4 cell counts. This is important, as pneumococcal vaccination coverage in PLWH is low in Europe and the United States, despite longstanding international recommendations. Methods We identified all CAP and IPD cases between 2008 and 2017 in a cohort of PLWH in a Dutch HIV referral center. We calculated incidence rates stratified by CD4 count and cART status and conducted a case-control study to identify risk factors for CAP in PLWH receiving cART. Results Incidence rates of IPD and CAP in PLWH were 111 and 1529 per 100 000 patient-years of follow-up (PYFU). Although IPD and CAP occurred more frequently in patients with CD4 counts <500 cells/μL (incidence rate ratio [IRR], 6.1 [95% confidence interval, 2.2–17] and IRR, 2.4 [95% confidence interval, 1.9–3.0]), the incidence rate in patients with CD4 counts >500 cells/μL remained higher compared with the general population (946 vs 188 per 100 000 PYFU). All IPD isolates were vaccine serotypes. Risk factors for CAP were older age, CD4 counts <500 cells/μL, smoking, drug use, and chronic obstructive pulmonary disease. Conclusions The incidence of IPD and CAP among PLWH remains higher compared with the general population, even in those who are virally suppressed and have high CD4 counts. With all serotyped IPD isolates covered by pneumococcal vaccines, our study provides additional argumentation against the poor current adherence to international recommendations to vaccinate PLWH. The incidence of pneumococcal disease and pneumonia among people living with HIV (PLWH) remains higher compared with the general population, even in those who are virally suppressed, and have high CD4 cell counts. Pneumococcal vaccination should be considered in all PLWH.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1058-4838 1537-6591 1537-6591
DOI:	10.1093/cid/ciz728