Invasive Pneumococcal Disease in People With Human Immunodeficiency Virus in England, 1999-2017.
Clin Infect Dis
; 73(1): 91-100, 2021 07 01.
Article
em En
| MEDLINE
| ID: mdl-32789498
ABSTRACT
BACKGROUND:
The 7-valent and 13-valent pneumococcal conjugate vaccines (PCVs) were introduced into the UK childhood immunization program in 2006 and 2010, respectively, with high effectiveness and resulting in both direct and indirect protection. We describe the epidemiology of invasive pneumococcal disease (IPD) in adults with human immunodeficiency virus (HIV) in England following the introduction of both PCVs.METHODS:
Data on a national cohort of people with HIV were linked to confirmed IPD cases in adults agedâ ≥â 15 years during 1999-2017. Date of HIV infection was estimated using a CD4 slope decline algorithm.RESULTS:
Among 133â 994 adults with HIV, 1453 developed IPD during 1999-2017, with 70% (1016/1453) developing IPDâ ≥â 3 months after their HIV diagnosis. IPD and HIV were codiagnosed within 90 days in 345 (24%) individuals. A missed opportunity for earlier HIV diagnosis was identified in 6% (89/1453), mostly in earlier years. IPD incidence in people with HIV increased from 147/100â 000 in 1999 to 284/100â 000 in 2007 before declining and stabilizing between 92 and 113/100â 000 during 2014-2017. Mean annual IPD incidence was lower among those receiving antiretroviral therapy during 2014-17 (68 vs 720/100â 000; incidence rate ratio [IRR] 9.3; 95% confidence interval [CI], 7.3-11.8; Pâ <â .001) and was markedly lower in those with a suppressed viral load (50 vs 523/100â 000; IRR 10.4; 95% CI, 7.6-14.1; Pâ <â .001). The latter group still had 4.5-fold higher (95% CI, 3.8-5.3; Pâ <â .001) IPD incidence compared to the general population (11.2/100â 000).CONCLUSIONS:
IPD incidence among people with HIV reduced after PCV13 introduction and has remained stable. Adults presenting with IPD should continue to be tested for HIV infection.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Infecções Pneumocócicas
/
Infecções por HIV
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article