HIVand STI Department, Health Protection Agency, London, UK.
AIDS. 2012 Jan 2;26(1):87-94. doi: 10.1097/QAD.0b013e32834dcf27.
To examine invasive pneumococcal disease (IPD) incidence, the impact of the 7-valent pneumococcal conjugate vaccines (PCV7s) programme on the distribution of Streptococcus pneumoniae serotypes and risk factors for IPD among HIV-positive adults.
We analysed adults (aged ≥15 years) reported to the HIV and IPD national datasets in England and Wales (2000-2009). Through data-linkage, changes in IPD incidence and serotype distribution were examined. Risk factors for IPD among HIV-positive adults were assessed using a case-control study.
Among 63,109 HIV-positive adults, 951 were co-infected with IPD. The average annual incidence of IPD was 245 episodes per 100,000 HIV-positive adults and 246 of 100,000 among those aged 15-44 years. Incidence was higher among those not on antiretroviral therapy (ART) (281 of 100,000) and those with severe immunosuppression (563 of 100,000). Among 9283 adults aged 15-44 at IPD diagnosis, 2.4% were living with undiagnosed HIV. The proportion of IPD episodes in HIV-positive adults with serotypes covered by PCV7 was 23% in 2009, a 54% proportional reduction compared with pre-PCV7 (2000-2006); the reduction in adults of unknown HIV status was 70%. The proportion of IPD episodes among HIV-positive adults caused by serotypes covered by PCV13 was 61%. Significant risk factors for IPD in multivariate analysis included older aged (≥65 years), a lower nadir CD4 cell count and no previous ART.
An HIV test should be offered and recommended to adults aged 15-44 years without other obvious IPD risk factors. Our study provides an evidence base to policy makers regarding the use of the new PCV13 in HIV-positive adults.
研究侵袭性肺炎球菌病（IPD）的发病率，7 价肺炎球菌结合疫苗（PCV7）计划对肺炎链球菌血清型分布的影响，以及艾滋病毒阳性成年人发生 IPD 的危险因素。
我们分析了英格兰和威尔士艾滋病毒和 IPD 国家数据集报告的成年人（年龄≥15 岁）（2000-2009 年）。通过数据链接，检查了 IPD 发病率和血清型分布的变化。采用病例对照研究评估艾滋病毒阳性成年人发生 IPD 的危险因素。
在 63109 名艾滋病毒阳性成年人中，有 951 人合并感染 IPD。每 100000 名艾滋病毒阳性成年人中，IPD 的年平均发病率为 245 例，年龄在 15-44 岁的成年人中为 246 例。未接受抗逆转录病毒治疗（ART）的成年人（每 100000 人中 281 例）和严重免疫抑制的成年人（每 100000 人中 563 例）的发病率更高。在诊断为 IPD 的 9283 名年龄在 15-44 岁的成年人中，有 2.4%的人患有未确诊的 HIV。在 2009 年，艾滋病毒阳性成年人中由 PCV7 涵盖血清型引起的 IPD 发生率为 23%，与 PCV7 前（2000-2006 年）相比，这一比例下降了 54%；对于 HIV 状态未知的成年人，这一比例下降了 70%。艾滋病毒阳性成年人中由 PCV13 涵盖血清型引起的 IPD 发生率为 61%。多变量分析中的显著危险因素包括年龄较大（≥65 岁）、最低 CD4 细胞计数较低和从未接受过 ART。
对于没有其他明显 IPD 危险因素的 15-44 岁成年人，应提供并建议进行 HIV 检测。我们的研究为决策者提供了关于在艾滋病毒阳性成年人中使用新的 PCV13 的证据基础。
