Medical Research Council: Respiratory and Meningeal Pathogens Research Unit & Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, South Africa.
AIDS. 2011 Feb 20;25(4):453-62. doi: 10.1097/QAD.0b013e328341b7f1.
HIV infection is a major risk factor for invasive pneumococcal disease (IPD). A national antiretroviral program was initiated in South Africa in 2004. This study evaluates the impact of the highly active antiretroviral therapy (HAART) treatment program on the burden of IPD among African children.
Retrospective analysis of laboratory-confirmed IPD among children under 18 years of age, from 2003 to 2008.
The periods 2003-2004, 2005-2006 and 2007-2008 were defined as the early, intermediate and established HAART eras, respectively. Pneumococcal conjugate vaccine was not introduced into public immunization during this period.
One thousand, one hundred and seventy-one episodes of IPD were identified over the study period. Among HIV-infected children under 18 years, the burden of IPD decreased by 50.8% [95% confidence interval (CI) 41.5-58.7] and the incidence of IPD-related mortality declined by 65.2% (95% CI 47.2-77.0) from the early compared to the established HAART era. This decline in HIV-infected children was evident for pneumococcal bacteremia and pneumococcal meningitis. In addition, similar reductions were observed for serotypes included in a 7-valent pneumococcal conjugate vaccine and nonvaccine serotypes. The burden of IPD remained unchanged in HIV-uninfected children under 18 years of age over these periods. The risk of IPD, however, remained 42-fold greater in HIV-infected compared to HIV-uninfected children in the established HAART era.
Although the HAART program has been associated with significant declines in IPD morbidity and mortality, HIV-infected African children with access to HAART remain a high-risk group for IPD. These children should therefore be prioritized in the prevention of IPD.
HIV 感染是侵袭性肺炎球菌病（IPD）的主要危险因素。南非于 2004 年启动了国家抗逆转录病毒治疗计划。本研究评估高效抗逆转录病毒治疗（HAART）治疗方案对非洲儿童 IPD 负担的影响。
回顾性分析 2003 年至 2008 年间 18 岁以下儿童实验室确诊的 IPD。
将 2003-2004 年、2005-2006 年和 2007-2008 年分别定义为 HAART 早期、中期和建立时期。在此期间，未将肺炎球菌结合疫苗纳入公共免疫计划。
在研究期间，共发现 1171 例 IPD 发作。在 18 岁以下的 HIV 感染儿童中，与早期 HAART 时期相比，IPD 的负担减少了 50.8%（95%CI 41.5-58.7），IPD 相关死亡率下降了 65.2%（95%CI 47.2-77.0）。与 HAART 建立时期相比，HIV 感染儿童的侵袭性肺炎球菌性菌血症和脑膜炎的发病率下降更为明显。此外，7 价肺炎球菌结合疫苗和非疫苗血清型的血清型也观察到类似的减少。在这些时期，18 岁以下的 HIV 未感染儿童的 IPD 负担保持不变。然而，在 HAART 建立时期，HIV 感染儿童患 IPD 的风险仍然比 HIV 未感染儿童高 42 倍。
尽管 HAART 方案与 IPD 发病率和死亡率的显著下降有关，但获得 HAART 的非洲 HIV 感染儿童仍然是 IPD 的高风险群体。因此，这些儿童应在预防 IPD 方面得到优先考虑。
