Respiratory Diseases Branch, Division of Bacterial Diseases, USA.
AIDS. 2010 Sep 10;24(14):2253-62. doi: 10.1097/QAD.0b013e32833d46fd.
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.
人类免疫缺陷病毒（HIV）感染和艾滋病会增加侵袭性肺炎球菌病（IPD）的风险。我们评估了美国 10 年间 HIV 感染者中侵袭性肺炎球菌病的发病情况，以确定预防 HIV 感染者侵袭性肺炎球菌病的机会。
七个基于人群和基于实验室的主动细菌性核心监测区的 IPD 和 HIV 监测。
1998-2007 年间，从正常无菌部位分离出肺炎球菌的 18-64 岁 IPD 病例被纳入研究。采用 Quellung 反应对分离株进行血清分型。通过病历回顾确定 HIV/AIDS 状态。我们使用全国基于病例的监测数据计算 AIDS 患者中 IPD 的发病率。
在 18-64 岁人群的 13812 例 IPD 病例中，3236 例（23%）发生在 HIV 感染者（有或无 AIDS）中，1313 例（10%）发生在 HIV 感染者 AIDS 亚组中。与美国儿童 7 价肺炎球菌结合疫苗（PCV7）引入前的时期（1998-1999 年）相比，2007 年 AIDS 患者中 IPD 的总发病率从 399 例/10 万人下降了 25%，降至 298 例（P = 0.008）。2006-2007 年，AIDS 患者中 IPD 的 8%、39%和 55%分别由包含在 7 价 PCV、13 价 PCV 和 23 价肺炎球菌多糖疫苗中的血清型引起。
在美国，AIDS 患者的侵袭性肺炎球菌病发病率持续下降，但在 PCV7 引入后 7 年仍居高不下。需要采取更积极的措施，包括 HIV 预防措施以及在儿童和可能的 HIV 感染者中使用新的 PCV，以进一步降低 HIV 感染者的侵袭性肺炎球菌病发病率。
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