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

Authors :
Albert M Vollaard
Hannah M. Garcia Garrido
Anne M R Mak
Ferdinand W. N. M. Wit
Abraham Goorhuis
Michael W.T. Tanck
Arie van der Ende
Mirjam J. Knol
Gino W M Wong
Martin P. Grobusch
Graduate School
AII - Infectious diseases
Infectious diseases
Epidemiology and Data Science
APH - Methodology
Medical Microbiology and Infection Prevention
APH - Aging & Later Life
APH - Global Health
Source :
Clinical infectious diseases, 71(1), 41-50. Oxford University Press
Publication Year :
2019

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 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 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.

Details

ISSN :
15376591 and 10584838
Volume :
71
Issue :
1
Database :
OpenAIRE
Journal :
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Accession number :
edsair.doi.dedup.....5e47cd85a9ca6e7e8f0401812bdb69f2