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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Increased incidence of meningococcal disease in HIV-infected individuals associated with higher case-fatality ratios in South Africa
AIDS, Volume 24, No. 9, Year 2010
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Description
OBJECTIVES: We aimed to compare the incidence of meningococcal disease amongst HIV-infected and uninfected individuals and to evaluate whether HIV is a risk factor for mortality and bacteremia amongst patients with meningococcal disease. DESIGN: Cohort surveillance study. METHODS: We conducted laboratory-based surveillance for meningococcal disease in Gauteng Province, South Africa. HIV status and outcome data were obtained at sentinel sites. Incidence in HIV-infected and uninfected persons was calculated assuming a similar age-specific HIV prevalence in tested and untested individuals. Risk factors for death and bacteremia (as compared with meningitis) were evaluated using multivariable logistic regression. RESULTS: From 2003 to 2007, 1336 meningococcal cases were reported. Of 504 patients at sentinel sites with known outcome, 308 (61%) had HIV serostatus data. HIV prevalence amongst cases of meningococcal disease was higher than the population HIV prevalence in all age groups. The incidence of meningococcal disease in HIV-infected individuals was elevated in all age groups with an age-adjusted relative risk of 11.3 [95% confidence interval (CI) 8.9-14.3, P < 0.001]. The case-fatality ratio (CFR) was 20% (27/138) amongst HIV-infected and 11% (18/170) amongst HIV-uninfected individuals [odds ratio (OR) 2.1, 95% CI 1.1-3.9]. On multivariable analysis, CFR was greater amongst patients with bacteremia (35%, 29/82) compared with meningitis (7%, 16/226) (OR 7.8, 95% CI 3.4-17.7). HIV infection was associated with increased odds of bacteremia (OR 2.7, 95% CI 1.5-5.0). CONCLUSION: HIV-infected individuals may be at increased risk of meningococcal disease. The increased CFR in HIV-infected patients may be explained by their increased odds of bacteremia compared to meningitis. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Authors & Co-Authors
Cohen, Cheryl D.
South Africa, Johannesburg
National Institute for Communicable Diseases
United States, Columbus
School of Public Health
Singh, Elvira
United States, Columbus
School of Public Health
Wu, Henry M.
United States, Atlanta
Office of Workforce and Career Development
United States, Atlanta
National Center for Immunization and Respiratory Diseases
Martin, Stacey W.
United States, Atlanta
National Center for Immunization and Respiratory Diseases
de Gouveia, Linda D.
South Africa, Johannesburg
National Institute for Communicable Diseases
Klugman, K. P.
South Africa, Johannesburg
National Institute for Communicable Diseases
South Africa, Johannesburg
School of Pathology
United States, Atlanta
Rollins School of Public Health
Meiring, Susan T.
South Africa, Johannesburg
National Institute for Communicable Diseases
Govender, Nelesh P.
South Africa, Johannesburg
National Institute for Communicable Diseases
South Africa, Johannesburg
School of Pathology
von Gottberg, Anne M.
South Africa, Johannesburg
National Institute for Communicable Diseases
South Africa, Johannesburg
School of Pathology
Statistics
Citations: 76
Authors: 9
Affiliations: 6
Identifiers
Doi:
10.1097/QAD.0b013e32833a2520
e-ISSN:
14735571
Research Areas
Infectious Diseases
Study Design
Cross Sectional Study
Cohort Study
Case-Control Study
Study Locations
South Africa