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Prevention of invasive pneumococcal disease among HIV-infected adults in the era of childhood pneumococcal immunization

2010; Lippincott Williams & Wilkins; Volume: 24; Issue: 14 Linguagem: Inglês

10.1097/qad.0b013e32833d46fd

1473-5571

Adam L. Cohen, Lee H. Harrison, Monica M. Farley, Arthur Reingold, James L. Hadler, William Schaffner, Ruth Lynfield, Ann Thomas, Michael Campsmith, Jianmin Li, Anne Schuchat, Matthew R. Moore,

Respiratory viral infections research

Human immunodeficiency virus (HIV) infection and AIDS increase the risk of invasive pneumococcal disease (IPD). We evaluated IPD among HIV-infected adults over a 10-year period in the US to identify opportunities for prevention of IPD among HIV-infected adults.IPD and HIV surveillance in seven population-based and laboratory-based Active Bacterial Core surveillance areas.IPD cases were adults 18-64 years old with pneumococcus isolated from a normally sterile site during 1998-2007. Isolates were serotyped using the Quellung reaction. HIV/AIDS status was determined by medical record review. We calculated incidence of IPD among adults with AIDS using national case-based surveillance data.Of 13 812 IPD cases among 18-64-year-olds, 3236 (23%) occurred among HIV-infected adults (with or without AIDS) and 1313 (10%) occurred among the subset of HIV-infected adults with AIDS. Compared with the period (1998-1999) before childhood 7-valent pneumococcal conjugate vaccine (PCV7) introduction in the US, the overall incidence of IPD among adults with AIDS decreased 25% from 399 to 298 cases per 100 000 by 2007 (P = 0.008). In 2006-2007, 8, 39 and 55% of IPD cases among adults with AIDS were caused by serotypes included in the 7-valent PCV, 13-valent PCV and 23-valent pneumococcal polysaccharide vaccines, respectively.Sustained declines in IPD have occurred among adults with AIDS in the US, but incidence remained high 7 years after PCV7 introduction. More aggressive efforts, including HIV-prevention measures and the use of new PCVs in children and possibly HIV-infected adults, are necessary to further reduce IPD among HIV-infected adults.