Invasive pneumococcal disease among HIV-positive individuals, 2000-2009
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Objectives: To examine invasive pneumococcal disease (IPD) incidence, the impact of the 7-valent pneumococcal conjugate vaccines (PCV7s) programme on the distribution of Streptococcus pneumoniae serotypes and risk factors for IPD among HIV-positive adults. Methods: We analysed adults (aged ≥15 years) reported to the HIV and IPD national datasets in England and Wales (2000–2009). Through data-linkage, changes in IPD incidence and serotype distribution were examined. Risk factors for IPD among HIV-positive adults were assessed using a case–control study. Results: Among 63 109 HIV-positive adults, 951 were co-infected with IPD. The average annual incidence of IPD was 245 episodes per 100 000 HIV-positive adults and 246 of 100 000 among those aged 15–44 years. Incidence was higher among those not on antiretroviral therapy (ART) (281 of 100 000) and those with severe immunosuppression (563 of 100 000). Among 9283 adults aged 15–44 at IPD diagnosis, 2.4% were living with undiagnosed HIV. The proportion of IPD episodes in HIV-positive adults with serotypes covered by PCV7 was 23% in 2009, a 54% proportional reduction compared with pre-PCV7 (2000–2006); the reduction in adults of unknown HIV status was 70%. The proportion of IPD episodes among HIV-positive adults caused by serotypes covered by PCV13 was 61%. Significant risk factors for IPD in multivariate analysis included older aged (≥65 years), a lower nadir CD4 cell count and no previous ART. Conclusion: An HIV test should be offered and recommended to adults aged 15–44 years without other obvious IPD risk factors. Our study provides an evidence base to policy makers regarding the use of the new PCV13 in HIV-positive adults.
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