The Role of Human Immunodeficiency Virus Infection in Pneumococcal Bacteremia in San Francisco Residents

Abstract

Human immunodeficiency virus (HIV) is an important risk factor for invasive pneumococcal disease, but information on clinical course and infecting serotypes is limited. To help develop strategies to reduce the morbidity due to invasive pneumococcal disease, episodes of pneumococcal bacteremia were identified by retrospective review of microbiology records (November 1983-November 1987) at 10 San Francisco hospitals and, for patients 20-55 years old living in San Francisco, HIV antibody status was determined by review of medical records. Pneumococcal isolates from one hospital were serotyped. Of 294 patients with pneumococcal bacteremia identified, 32 (11%) had AIDS at the time pneumococcal bacteremia was diagnosed and another 43 (15%) were HIV-infected but did not have AIDS; 12 HIV-infected patients developed AIDS after the episode of pneumococcal bacteremia. The rate of pneumococcal bacteremia in AIDS patients was estimated to be 9.4/1000 patient-years. Serotypes of 27 (82%) of 33 pneumococcal isolates from HIV-infected patients and 107 (90%) from 119 patients without known HIV infection were among the 23 serotypes included in the currently available polysaccharide vaccine. The rate of pneumococcal bacteremia is approximately 100-fold greater in AIDS patients in San Francisco than rates reported before the AIDS epidemic, but more than half the episodes of pneumococcal bacteremia in HIV-infected patients occurred in patients without AIDS. Data on pneumococcal serotypes causing invasive disease in HIV-infected patients suggest that the current pneumococcal vaccine, if effective in this population, could provide significant protection against pneumococcal disease.

A 5‐year longitudinal follow‐up study of serological responses to 23‐valent pneumococcal polysaccharide vaccination among patients with HIV infection who received highly active antiretroviral therapy*

“…DOI: 10.1111/j.1468-1293.2009.00744.x HIV Medicine (2010 r 2009 British HIV Association 54 antiretroviral therapy (HAART) [1]. Although cohort or population-based surveillance studies suggest that the incidence of invasive pneumococcal infections or pneumococcal pneumonia declines among HIV-infected patients with access to HAART and appropriate antimicrobial prophylaxis [2,4,6,7], it remains significantly higher among HIV-infected patients than in the general population, with risk ratios ranging from 35 to 60 [2][3][4].…”

“…Patients with HIV infection are at significantly higher risk for invasive infection with Streptococcus pneumoniae as compared with persons without HIV infection [1][2][3][4][5]. Rates of invasive pneumococcal infection among HIV-infected patients may be as much as 100-fold greater than among HIV-negative controls in the absence of highly active antiretroviral therapy (HAART) [1].…”

Immunization of HIV-infected adult patients — French recommendations

“…25 With the advent of ART, the incidence of these infections dropped by half, but remains much greater than in noninfected people. 26,27 In the developed world, the annual incidence of IPD among HIV-positive adults is estimated to be 245 cases/100 000.…”

Community-acquired pneumonia in adult HIV-infected patients: course, treatment, and prevention

“…В период до АРВТ пневмококковая бактериемия ре гистрировалась у ВИЧ инфицированных более чем в 100 раз чаще, чем у людей без ВИЧ [39]. Выявлено, что в отличие от других патогенов, частота возник новения пневмококковой бактериемии особенно четко коррелирует со степенью иммуносупрессии, при этом низкий уровень CD4 служит прогностичес ким фактором отсроченного ответа на терапию [40].…”