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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Incidence and risk factors for invasive pneumococcal disease and community-acquired pneumonia in human immunodeficiency virus-infected individuals in a high-income setting
Clinical Infectious Diseases, Volume 71, No. 1, Year 2020
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Description
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 Author(s) 2019.
Authors & Co-Authors
Wit, Ferdinand W.N.M.
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Knol, Mirjam J.
Netherlands, Bilthoven
Rijksinstituut Voor Volksgezondheid en Milieu
Vollaard, Albert M.
Netherlands, Bilthoven
Rijksinstituut Voor Volksgezondheid en Milieu
Tanck, Michael W.T.
Unknown Affiliation
van der Ende, Arie D.
Netherlands, Amsterdam
Universiteit Van Amsterdam
Grobusch, Martín Peter
Netherlands, Amsterdam
Centre of Tropical Medicine and Travel Medicine
Goorhuis, Abram
Netherlands, Amsterdam
Centre of Tropical Medicine and Travel Medicine
Statistics
Citations: 26
Authors: 7
Affiliations: 4
Identifiers
Doi:
10.1093/cid/ciz728
ISSN:
10584838
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study
Cohort Study
Case-Control Study