Ms. Dworkin et al., Pneumococcal disease among human immunodeficiency virus-infected persons: Incidence, risk factors, and impact of vaccination, CLIN INF D, 32(5), 2001, pp. 794-800
To determine the factors associated with pneumococcal disease (pneumococcal
pneumonia or invasive disease) and the impact of pneumococcal vaccine in H
IV-infected persons, we analyzed patient data collected by the Adult and Ad
olescent Spectrum of HIV Disease Project for person-time between January 19
90 and December 1998. Among 39,086 persons with 71,116 person-years (py) of
observation, 585 episodes of pneumococcal disease were diagnosed (incidenc
e, 8.2 episodes per 1000 py). Factors associated with an increased risk for
pneumococcal disease (P<.05) included injection drug use (adjusted relativ
e risk [RR], 1.5) and blood transfusion (RR, 2.0) as the mode of HIV transm
ission (referent, male-male sex); black race/ethnicity (RR, 1.5; referent,
white race); history of acquired immunodeficiency syndrome (AIDS)-defining
opportunistic illness (RR, 2.1); a CD4(+) cell count of 200-499 cells/<mu>L
(RR, 2.5) or <200 cells/<mu>L (RR, 3.7; referent, CD4(+) cell count of >50
0 cells/muL); and alcoholism (RR, 2.0). Factors associated with a decreased
risk included prescription of antiretroviral therapy (RR for monotherapy,
0.6; for dual therapy, 0.7; for triple therapy, 0.5) and pneumococcal vacci
nation (RR for persons vaccinated at a CD4(+) cell count of greater than or
equal to 500 cells/muL, 0.5). We recommend that pneumococcal vaccine be gi
ven to HIV-infected persons before profound immunosuppression has occurred.