28% (1360/4890); 45% (520/1154) in meningitis and 22% (840/3736) in other IPD cases (p < 0.001). Of patients tested for HIV, HIV-seroprevalence was 512/664 (77%) amongst meningitis cases and 2062/2346 (88%) amongst other IPD (p < 0.001). On multivariable analysis of meningitis cases, HIV-coinfection was associated with increased odds of death when controlling for age group, severity of illness [Pitt bacteraemia score], prior antibiotic use and province (odds ratio 2.2, 95% confidence interval 1.3-3.6). HIV-coinfection was not an independent risk factor for death in other IPD cases.Conclusions: Pneumococcal meningitis has a high mortality in South Africa, and HIV-infected patients are at increased risk of death. Access to antiretroviral therapy for HIV-positive patients and introduction of the pneumococcal conjugate vaccine for routine immunization should be prioritized.
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