Reuters Health Information (2005-07-15): Epidemiology of pneumococcal disease in HIV shows post-HAART shift
Epidemiology of pneumococcal disease in HIV shows post-HAART shift
Last Updated: 2005-07-15 15:02:15 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Highly active
antiretroviral therapy (HAART), along with the use of pneumococcal
vaccines, appears to have reduced the incidence of bacteremic
pneumococcal disease among HIV-infected individuals, Spanish and German
And in the post-HAART era, the researchers found, HIV patients' risk
factors for pneumococcal disease are becoming more similar to those
seen in people without HIV.
There is evidence that the incidence of invasive pneumococcal
infection among people with HIV is in decline, which could be due both
to the introduction of HAART and the use of pneumococcal vaccines, Dr.
Roman Pallares of IDIBELL-Hospital de Bellvitge in Barcelona and
colleagues write in the July 11 issue of the Archives of Internal
The researchers prospectively studied 142 episodes of pneumococcal
bacteremia in 122 adults with HIV. Eighty-five of the infections
occurred in 1986-1996, defined as the pre-HAART era, while 57 occurred
after the introduction of HAART in 1997-2001.
Pre-HAART, pneumococcal bacteremia incidence was 24.1 episodes per
1,000 patient years, while post-HAART it fell to 8.2. Patients who
developed the infection after HAART had a higher mortality rate and
more associated comorbidity.
Patients with associated comorbidity, usually cirrhosis of the
liver, were more than three times more likely than those with no such
comorbidity to develop pneumococcal bacteremia in the post-HAART era,
while those who abused alcohol or smoked cigarettes had a more than
five-fold greater risk. Prior hospitalization tripled the risk, while
having a CD4 cell count below 100 cells per microliter more than
HAART use cut pneumococcal bacteremia risk by 63%, while pneumococcal vaccine reduced risk by 61%.
As patients with HIV are living longer, the researchers note,
comorbidities such as hepatitis C infection and HAART-linked
cardiovascular disease and diabetes mellitus may become more important
as risk factors for pneumococcal disease.
"In the HAART era, the increasing prevalence of comorbidities that
are well-known risk factors for pneumococcal infection (e.g. chronic
liver disease, diabetes, and cardiovascular diseases) may foretell a
continuing global burden of infectious disease in the HIV-infected
population," they conclude.
Arch Intern Med 2005;165:1533-1540.