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Chowers M, Regev-Yochay G, Mor O, Cohen-Poradosu R, Riesenberg K, Zimhony O, Chemtob D, Stein M, Dagan R, Levy I. Invasive pneumococcal disease (IPD) in HIV infected patients in Israel since the introduction of pneumococcal conjugated vaccines (PCV): Analysis of a nationwide surveillance study, 2009-2014. Hum Vaccin Immunother 2017; 13:216-219. [PMID: 27648488 DOI: 10.1080/21645515.2016.1229720] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
STUDY AIM to assess the incidence, risk factors and outcome of invasive pneumococcal disease (IPD) among the Israeli HIV population. A matched case-control study nested in a nationwide, prospective, population-based, cohort of adult IPD was performed. In addition, the HIV-IPD patients were compared to the general adult HIV population in Israel. STUDY PERIOD from the introduction of PCV into the national immunization program (NIP) in July 2009 to June 2014. Each HIV patient within the IPD cohort was matched to 4 non-HIV controls. Serotyping was performed by a central laboratory using the Quellung reaction. Thirty-five IPD episodes in 33 HIV patients were identified, with a median annual incidence of 128/100,000 HIV+ persons compared to 5.1/100,000 in the age-matched, non-HIV population. Compared to the general HIV population, HIV-IPD patients practiced intravenous drug use more frequently and originated from a country with generalized epidemic (OGE), mainly non-citizens lacking medical insurance. The proportion of men who have sex with men (MSM) was lower than in the general HIV population. Pneumonia was the most common clinical presentation (81%), while meningitis occurred in only one patient. Outcomes were similar to those of the IPD non-HIV population. Nineteen serotypes were identified, of which only 42% were covered by PCV13 vaccine. By 2014, none of the HIV-IPD cases belonged to serotypes covered by PCV13. In conclusion, most HIV IPD cases were from marginalized populations with poor access to health services. A decrease in IPD cases covered by PCV 13 was observed.
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Affiliation(s)
- Michal Chowers
- a Infectious Diseases Unit, Meir Medical Center, Kfar Saba, and the Sackler Faculty of Medicine, Tel Aviv University , Ramat Aviv , Israel
| | - Gili Regev-Yochay
- b Infectious Diseases Unit, Sheba Medical Center, Ramat Gan, and the Sackler Faculty of Medicine, Tel Aviv University , Ramat Aviv , Israel
| | - Orna Mor
- c Central Virology Laboratory, The Israeli Ministry of Health, Sheba Medical Center , Ramat Gan , Israel
| | | | - Klaris Riesenberg
- e Infectious Diseases Unit, Soroka Medical Center, and the Faculty of Health Sciences, Ben-Gurion University of the Negev , Beer Sheva , Israel
| | - Oren Zimhony
- f Infectious Diseases Unit, Kaplan Medical Center , Rehovot , Israel
| | - Daniel Chemtob
- g Department of Tuberculosis & AIDS , the Israeli Ministry of Health , Jerusalem , Israel
| | - Michal Stein
- h Infectious Diseases Unit, Hillel Yaffe Medical Center , Hadera , Israel
| | - Ron Dagan
- i the Faculty of Health Sciences, Ben Gurion University of the Negev , Beer Sheva , Israel
| | - Itzchak Levy
- j Infectious Diseases Unit Sheba Medical Center, Ramat Gan, and the Sackler Faculty of Medicine, Tel Aviv University , Ramat Aviv , Israel
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Lesourd A, Leporrier J, Delbos V, Unal G, Honoré P, Etienne M, Bouchaud O, Caron F. Antiretroviral Therapy as Prevention of … Pneumococcal Infections? Open Forum Infect Dis 2016; 3:ofw228. [PMID: 28018929 PMCID: PMC5170497 DOI: 10.1093/ofid/ofw228] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 10/21/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Despite antiretroviral therapy, it is generally believed that the risk for pneumococcal infections (PnIs) is high among patients infected with human immunodeficiency virus (HIV). However, most studies in this field have been conducted before 2010, and the proportion of virologically suppressed patients has drastically increased in these latter years thanks to larger indications and more effective antiretroviral regimens. This study aimed to re-evaluate the current risk of PnI among adult patients infected with HIV. METHODS The incidence of PnI was evaluated between 1996 and 2014 in 2 French regional hospitals. The 80 most recent cases of PnI (2000-2014) were retrospectively compared with 160 controls (HIV patients without PnI) to analyze the residual risk factors of PnI. RESULTS Among a mean annual follow-up cohort of 1616 patients, 116 PnIs were observed over 18 years. The risk factors of PnI among patients infected with HIV were an uncontrolled HIV infection or "classic" risk factors of PnI shared by the general population such as addiction, renal or respiratory insufficiency, or hepatitis B or C coinfection. Pneumococcal vaccination coverage was low and poorly targeted, because only 5% of the cases had been previously vaccinated. The incidence of invasive PnIs among HIV patients with a nonvirologically suppressed infection or comorbidities was 12 times higher than that reported in the general population at the country level (107 vs 9/100000 patients), whereas the incidence among virologically suppressed HIV patients without comorbidities was lower (7.6/100000 patients). CONCLUSIONS Human immunodeficiency virus infection no longer per se seems to be a significant risk factor for PnI, suggesting a step-down from a systematic to an "at-risk patient" targeted pneumococcal vaccination strategy.
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Affiliation(s)
- Anaïs Lesourd
- Centre Hospitalo-Universitaire Charles Nicolle, Service de Maladies Infectieuses et Tropicales , Rouen, France
| | - Jérémie Leporrier
- Centre Hospitalo-Universitaire Charles Nicolle, Service de Maladies Infectieuses et Tropicales , Rouen, France
| | - Valérie Delbos
- Centre Hospitalo-Universitaire Charles Nicolle, Service de Maladies Infectieuses et Tropicales, Rouen, France;; Groupe de Recherche sur l'Adaptation Microbienne (2.0-EA 2656, Institut de Recherche et d'Innovation Biomédicale), Normandie Université, Rouen, France
| | - Guillemette Unal
- Centre Hospitalo-Universitaire Charles Nicolle, Service de Maladies Infectieuses et Tropicales, Rouen, France;; Groupe de Recherche sur l'Adaptation Microbienne (2.0-EA 2656, Institut de Recherche et d'Innovation Biomédicale), Normandie Université, Rouen, France
| | - Patricia Honoré
- Centre Hospitalo-Universitaire Avicenne, Service de Maladies Infectieuses et Tropicales , Bobigny, France
| | - Manuel Etienne
- Centre Hospitalo-Universitaire Charles Nicolle, Service de Maladies Infectieuses et Tropicales, Rouen, France;; Groupe de Recherche sur l'Adaptation Microbienne (2.0-EA 2656, Institut de Recherche et d'Innovation Biomédicale), Normandie Université, Rouen, France
| | - Olivier Bouchaud
- Centre Hospitalo-Universitaire Avicenne, Service de Maladies Infectieuses et Tropicales , Bobigny, France
| | - François Caron
- Centre Hospitalo-Universitaire Charles Nicolle, Service de Maladies Infectieuses et Tropicales, Rouen, France;; Groupe de Recherche sur l'Adaptation Microbienne (2.0-EA 2656, Institut de Recherche et d'Innovation Biomédicale), Normandie Université, Rouen, France
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Zhang L, Li Z, Wan Z, Kilby A, Kilby JM, Jiang W. Humoral immune responses to Streptococcus pneumoniae in the setting of HIV-1 infection. Vaccine 2015; 33:4430-6. [PMID: 26141012 DOI: 10.1016/j.vaccine.2015.06.077] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 06/07/2015] [Accepted: 06/19/2015] [Indexed: 02/06/2023]
Abstract
Streptococcus pneumoniae (pneumococcus) remains one of the most commonly identified causes of bacterial infection in the general population, and the risk is 30-100 fold higher in HIV-infected individuals. Both innate and adaptive host immune responses to pneumococcal infection are important against pathogen invasion. Pneumococcal-specific IgA antibody (Ab) is key to control infection at the mucosal sites. Ab responses against pneumococcal infection by B cells can be generated through T cell-dependent or T cell-independent pathways. Depletion of CD4+ T cells is a hallmark of immunodeficiency in HIV infection and this defect also contributes to B cell dysfunction, which predisposes to infections such as the pneumococcus. Two pneumococcal vaccines have been demonstrated to have potential benefits for HIV-infected patients. One is a T cell dependent 13-valent pneumococcal conjugate vaccine (PCV13); the other is a T cell independent 23-valent pneumococcal polysaccharide vaccine (PPV23). However, many questions remain unknown regarding these two vaccines in the clinical setting in HIV disease. Here we review the latest research regarding B cell immune responses against pneumococcal antigens, whether derived from potentially invading pathogens or vaccinations, in the setting of HIV-1 infection.
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Affiliation(s)
- Lumin Zhang
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Zihai Li
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Zhuang Wan
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Andrew Kilby
- Division of Infectious Diseases, Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States
| | - J Michael Kilby
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC 29425, United States; Division of Infectious Diseases, Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Wei Jiang
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC 29425, United States; Division of Infectious Diseases, Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States.
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Harboe ZB, Larsen MV, Ladelund S, Kronborg G, Konradsen HB, Gerstoft J, Larsen CS, Pedersen C, Pedersen G, Obel N, Benfield T. Incidence and risk factors for invasive pneumococcal disease in HIV-infected and non-HIV-infected individuals before and after the introduction of combination antiretroviral therapy: persistent high risk among HIV-infected injecting drug users. Clin Infect Dis 2014; 59:1168-76. [PMID: 25038114 DOI: 10.1093/cid/ciu558] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Invasive pneumococcal disease (IPD) is an important cause of morbidity among individuals infected with human immunodeficiency virus (HIV). We described incidence and risk factors for IPD in HIV-infected and uninfected individuals. METHODS Nationwide population-based cohort study of HIV-infected adults treated at all Danish HIV treatment centers during 1995-2012. Nineteen population-matched controls per HIV-infected individual were retrieved. The risk of IPD was assessed using Poisson regression. RESULTS The incidence of IPD was 304.7 cases per 100 000 person-years of follow-up (PYFU) in HIV-infected and 12.8 per 100 000 PYFU in HIV-uninfected individuals. After adjusting for confounders, HIV infection (relative risk [RR], 24.4 [95% confidence interval [CI], 23.7-25.1]), male sex (RR, 1.20 [95% CI, 1.16-1.24]), increasing age (per year) (RR, 1.03 [95% CI, 1.03-1.04]), and calendar period (pre-cART RR, 2.80 [95% CI, 2.70-2.91] compared with late cART) were significantly associated with an increased risk of IPD. Among HIV-infected individuals, male sex (RR, 1.57 [95% CI, 1.49-1.66]), smoking (RR, 1.34 [95% CI, 1.26-1.42]), and injecting drug use (RR, 2.51 [95% CI, 2.26-2.67]) were associated with an increased risk of IPD. Detectable viral loads (RR, 1.88 [95% CI, 1.79-1.98]) and a relative fall in CD4 T-cell counts were also associated with an increased risk (≥500 to 350-500 CD4 T cells/µL: RR, 1.29 [95% CI, 1.21-1.37] and <100 cells/µL: RR, 7.4 [95% CI, 6.87-8.02]). The risk of IPD declined over time, although this was not the case for IDUs where the risk remained unchanged. CONCLUSIONS The incidence of IPD in HIV-infected individuals remained significantly higher than the incidence observed in non-HIV-infected subjects, despite the widespread use of cART. IDUs have a persistently high risk of IPD. Injecting drug use, smoking, and the receipt of cART are suitable targets for preventive measures in the future.
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Affiliation(s)
- Zitta Barrella Harboe
- Department of Infectious Diseases, Rigshospitalet Neisseria and Streptococcus Reference Laboratory, Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen
| | - Mette Vang Larsen
- Department of Infectious Diseases and Clinical Research Center, Copenhagen University Hospital, Hvidovre
| | - Steen Ladelund
- Department of Infectious Diseases and Clinical Research Center, Copenhagen University Hospital, Hvidovre
| | - Gitte Kronborg
- Department of Infectious Diseases and Clinical Research Center, Copenhagen University Hospital, Hvidovre Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen
| | - Helle Bossen Konradsen
- Neisseria and Streptococcus Reference Laboratory, Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen
| | - Jan Gerstoft
- Department of Infectious Diseases, Rigshospitalet
| | | | - Court Pedersen
- Department of Infectious Diseases, Odense University Hospital
| | - Gitte Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Rigshospitalet Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen
| | - Thomas Benfield
- Department of Infectious Diseases and Clinical Research Center, Copenhagen University Hospital, Hvidovre Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen
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Bacteremia, causative agents and antimicrobial susceptibility among HIV-1-infected children on antiretroviral therapy in Uganda and Zimbabwe. Pediatr Infect Dis J 2013; 32:856-62. [PMID: 23407100 DOI: 10.1097/inf.0b013e31828c3991] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Bacteremia is common in HIV-infected children in Africa, including after start of antiretroviral therapy (ART), but there are limited data on causative pathogens and their antimicrobial sensitivity patterns in this population. METHODS We analyzed data on blood cultures taken from HIV-infected children developing acute febrile illness after enrollment to the Antiretroviral Research for Watoto (ARROW) clinical trial in Uganda and Zimbabwe. Patterns of bacterial pathogens and their antimicrobial susceptibilities were determined and bacteremia rates calculated over time from ART initiation. RESULTS A total of 848 blood cultures were obtained from 461 children, of which 123 (14.5%) from 105 children (median age 3.5 years, 51% girls) were culture positive, including 75 (8.8%) with clearly pathogenic organisms. The event rates for positive cultures with clearly pathogenic organisms after 0-1, 2-3, 4-11 and ≥12 months on ART were 13.3, 11.4, 2.1 and 0.3 per 1000 person-months of follow-up, respectively. The pathogens isolated (n; %) were Streptococcus pneumoniae (36; 28.3%), Staphylococcus aureus (11; 8.7%), Klebsiella pneumoniae (6; 4.7%), Pseudomonas aeruginosa (6; 4.7%), Salmonella spp (6; 4.7%), Escherichia coli (5; 3.9%), Haemophilus influenzae (1; 0.8%) and fungal spp (4; 3.1%). Other bacteria of doubtful pathogenicity (n = 52; 42%) were also isolated. Most isolates tested were highly (80-100%) susceptible to ceftriaxone, cefotaxime and ciprofloxacin; very few (~5%) were susceptible to cotrimoxazole; S. pneumoniae had high susceptibility to amoxicillin/ampicillin (80%). CONCLUSIONS Rates of proven bacteremia were >20-fold higher immediately after starting ART compared with 12 months later in African HIV-infected children. S. pneumoniae was most commonly isolated, suggesting need for pneumococcal vaccination and effective prophylactic antibiotics.
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Predominance of methicillin-resistant Staphylococcus aureus among HIV positive subjects with pyrexia of unknown origin in Chennai, Southern India. J Infect 2009; 58:313-4. [DOI: 10.1016/j.jinf.2009.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Revised: 02/11/2009] [Accepted: 02/12/2009] [Indexed: 12/26/2022]
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Imaz A, Falcó V, Peñaranda M, Jordano Q, Martínez X, Nadal C, Curran A, Planes AM, Dalmau D, Ribera E, Riera M, Ruiz de Gopegui E, Pahissa A. Impact of prior pneumococcal vaccination on clinical outcomes in HIV-infected adult patients hospitalized with invasive pneumococcal disease. HIV Med 2009; 10:356-63. [PMID: 19490180 DOI: 10.1111/j.1468-1293.2009.00695.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Recent studies in hospitalized patients with community-acquired pneumonia have found a lower risk of bacteraemia and better clinical outcomes in patients who had previously received the 23-valent pneumococcal polysaccharide vaccine (PPV) in comparison with unvaccinated individuals. The aim of this study was to assess the influence of prior PPV on clinical outcomes in HIV-infected adult patients hospitalized with invasive pneumococcal disease (IPD). METHODS This was an observational study of all consecutive HIV-infected adults hospitalized with IPD from January 1996 to October 2007 in three hospitals in Spain. Baseline characteristics and clinical outcome-related variables were compared according to prior PPV vaccination status. RESULTS A total of 162 episodes of IPD were studied. In 23 of these (14.2%), patients had previously received PPV. In both vaccinated and unvaccinated patients, most of the causal serotypes were included in the 23-valent PPV (76.9% and 84.1%, respectively). Overall, 25 patients (15.4%) died during hospitalization, 21 patients (13%) required admission to an intensive care unit (ICU) and 34 patients (21%) reached the composite outcome of death and/or admission to the ICU. None of the 23 patients who had previously received PPV died or required ICU admission, in comparison with 25 (18%; P=0.026) and 21 (15.1%; P=0.046), respectively, of the unvaccinated patients. The length of hospital stay for vaccinated patients was significantly shorter (8.48 vs. 13.27 days; P=0.011). CONCLUSIONS Although 23-valent PPV failed to prevent IPD in some HIV-infected patients, vaccination produced beneficial effects on clinical outcomes by decreasing illness severity and mortality related to IPD.
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Affiliation(s)
- A Imaz
- Infectious Disease Department, Hospital Universitari Vall d'Hebron, Autonomous University of Barcelona, P Vall d'Hebron 119-129, Barcelona 08035, Spain.
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Rizzi EB, Schininá V, Rovighi L, Cristofaro M, Bordi E, Narciso P, Bibbolino C. HIV-related pneumococcal lung disease: does highly active antiretroviral therapy or bacteremia modify radiologic appearance? AIDS Patient Care STDS 2008; 22:105-11. [PMID: 18260801 DOI: 10.1089/apc.2007.0028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We reviewed chest radiographs of 57 HIV-infected patients with pulmonary diseases in whom Streptococcus pneumoniae was the sole respiratory pathogen isolated to evaluate whether highly active antiretroviral therapy (HAART) or bacteremia modify radiographic appearance. Pneumococcal lung disease presented as lobar pneumonia in 40% of the cases, 54% of whom were on HAART; as bronchopneumonia in 42%, 58% on HAART; as interstitial infiltrates in 17%, 60% on HAART. Bacteremia was observed 38 times in 23 patients with CD4 less than 200/mm(3), and in 15 with CD4 greater than 200/mm(3) (p > 0.05). HAART does not significantly influences radiographic appearances of lung disease caused by Streptococcus pneumoniae (p > 0.05). Immunosuppression induced by HIV infection was a major risk factor for development of pneumococcal lung disease (p = 0.04) and influences radiographic appearance; bronchopneumonia (p = 0.006), in particular multifocal (p = 0.008), which was more frequent in subjects with CD4 less than 200/mm(3). Bacteremia influences radiographic appearance of pneumococcal lung disease; lobar pneumonia was more frequent (p = 0.003), and considering CD4 cell count, was more frequent if CD4 cell count was above 200/mm(3). An original finding of this study was the frequency of interstitial changes. This pattern of pneumonia, found in 17% of our patients, could represent a difference between HIV-seropositive and -seronegative subject in displaying pneumococcal lung disease.
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Affiliation(s)
- Elisa Busi Rizzi
- Department of Radiology, L Spallanzani National institute for infectious diseases, Rome, Italy
| | - Vincenzo Schininá
- Department of Radiology, L Spallanzani National institute for infectious diseases, Rome, Italy
| | - Laura Rovighi
- Department of Radiology, L Spallanzani National institute for infectious diseases, Rome, Italy
| | - Massimo Cristofaro
- Department of Radiology, L Spallanzani National institute for infectious diseases, Rome, Italy
| | - Eugenio Bordi
- Department of Radiology, L Spallanzani National institute for infectious diseases, Rome, Italy
| | - Pasquale Narciso
- Department of Radiology, L Spallanzani National institute for infectious diseases, Rome, Italy
| | - Corrado Bibbolino
- Department of Radiology, L Spallanzani National institute for infectious diseases, Rome, Italy
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Bliss SJ, O'Brien KL, Janoff EN, Cotton MF, Musoke P, Coovadia H, Levine OS. The evidence for using conjugate vaccines to protect HIV-infected children against pneumococcal disease. THE LANCET. INFECTIOUS DISEASES 2007; 8:67-80. [PMID: 17974480 DOI: 10.1016/s1473-3099(07)70242-6] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Pneumococcal conjugate vaccines (PCVs) are a potentially useful complement to existing treatment strategies in HIV-infected children, for whom pneumococcal infections are common and serious. This Review summarises available data on the burden of pneumococcal disease and the safety and efficacy of PCVs in HIV-infected children. The data demonstrate that children with HIV have significantly increased risk of pneumococcal disease compared with uninfected children; the serotypes included in currently licensed or near-licensure conjugate vaccines include most serotypes that cause invasive pneumococcal disease (IPD) in HIV-infected children and adults; PCVs provide substantial protection against IPD and clinical pneumonia when given to HIV-infected infants; and HIV-infected adults gain an indirect benefit when children in the community are vaccinated. PCV should be considered as an important intervention for improving the lives of HIV-infected children.
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Affiliation(s)
- Sandra J Bliss
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA.
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Feldman C, Klugman KP, Yu VL, Ortqvist A, Choiu CCC, Chedid MBF, Rello J, Wagener M. Bacteraemic pneumococcal pneumonia: Impact of HIV on clinical presentation and outcome. J Infect 2007; 55:125-35. [PMID: 17524486 DOI: 10.1016/j.jinf.2007.04.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Revised: 04/03/2007] [Accepted: 04/03/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The objectives of this study were to investigate the clinical and laboratory features, hospital course and outcome of patients with bacteraemic pneumococcal pneumonia, comparing HIV with non-HIV patients, as well as HIV patients from different parts of the world. METHODS This was a multicentre prospective observational study of consecutive adult cases with bacteraemic pneumococcal pneumonia in 10 countries on 6 continents. RESULTS A total of 768 cases were recruited, of which 200 were HIV-infected; 166 were from South Africa. Lower age, i.v. drug use, fewer co-morbid illnesses, and a higher frequency of respiratory symptoms were significantly more likely to occur in HIV patients. The 14-day mortality for the group as a whole was 14.5%, being 16% in the HIV patients and 13.9% in the non-HIV patients (not significant). When adjustments were made for age and severity of illness, HIV patients had significantly higher 14-day mortality with significant trend for increasing 14-day mortality in those with lower CD4 counts. Despite differences in various clinical and laboratory parameters in patients from different parts of the world, on multivariate analysis, when adjusting for regional differences, the HIV-infected patients were still noted to have poorer 14-day mortality. CONCLUSIONS This study, in contrast to previous investigations, indicates that there are significant differences in the clinical presentation and outcome of bacteraemic pneumococcal pneumonia when comparing HIV and non-HIV patients.
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Affiliation(s)
- Charles Feldman
- Division of Pulmonology, Department of Medicine, Johannesburg Hospital, University of the Witwatersrand, Medical School, 7 York Road, Parktown 2193, Johannesburg, South Africa.
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Abstract
PURPOSE OF REVIEW To describe the impact of highly active antiretroviral therapy on the burden of pneumococcal disease and advances in our understanding of the impact of HIV on this disease. RECENT FINDINGS Although highly active antiretroviral therapy has reduced the burden of pneumococcal disease among HIV-infected adults, these infections remain far more common than in HIV uninfected adults. HIV-infected adults who smoke or have comorbidities are at particular risk. In the absence of highly active antiretroviral therapy, pneumococcal meningitis has emerged in Africa as a major disease burden with a high mortality among HIV-infected children and adults. Conjugate pneumococcal vaccine protects HIV-infected infants from pneumococcal pneumonia. In the United States, where conjugate vaccine is given to children, herd immunity has reduced the burden of invasive pneumococcal disease among HIV-infected adults. SUMMARY The pneumococcus remains a significant cause of morbidity and mortality among HIV-infected children and adults, both in developed and in developing countries.
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Affiliation(s)
- Keith P Klugman
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA.
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Barry PM, Zetola N, Keruly JC, Moore RD, Gebo KA, Lucas GM. Invasive pneumococcal disease in a cohort of HIV-infected adults: incidence and risk factors, 1990-2003. AIDS 2006; 20:437-44. [PMID: 16439878 DOI: 10.1097/01.aids.0000206507.54901.84] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To investigate the association between the introduction of HAART and invasive pneumococcal disease (IPD) in HIV-infected patients. METHODS Incidence of IPD was determined from 1990 to 2003 in a cohort of HIV-infected individuals and a nested case-control study assessed risk factors of IPD. RESULTS There were 72 cases over 19,020 person-years of follow-up (overall IPD rate, 379/100,000 person-years). In the calendar periods 1990-1995, 1995-1998, and 1998-2003, the IPD incidence per 100,000 person-years was 279 [95% confidence interval (CI), 150-519], 377 (95% CI, 227-625) and 410 (95% CI, 308-545), respectively (P = 0.516). CD4 cell count < 200 cells/microl [odds ratio (OR), 3.0; 95% CI, 1.2-7.6), HIV RNA > 50,000 copies/ml (OR, 2.8; 95% CI, 1.2-6.5), hepatitis C (OR, 4.9; 95% CI, 1.7-14.9), serum albumin (OR, 0.1; 95% CI, 0.04-0.5), injection drug use in women (OR, 3.8; 95% CI, 1.6-8.8), and education beyond high school (OR, 0.2; 95% CI, 0.05-0.8) were significantly associated with IPD in multivariate analysis. No treatment factor, including HAART (OR, 0.7; 95% CI, 0.3-1.5) and pneumococcal vaccination (OR, 0.9; 95% CI, 0.5-1.6), was associated with IPD. CONCLUSIONS IPD incidence did not change significantly during the widespread dissemination of HAART in this cohort. IPD risk was associated with several sociodemographic and clinical factors.
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Affiliation(s)
- Pennan M Barry
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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