Invasive pneumococcal disease in HIV-infected adults: Clinical changes after the introduction of the pneumococcal conjugate vaccine in children

Joaquin Burgos, Maria Peñaranda, Antoni Payeras, Aroa Villoslada, Adrian Curran, Margarita Garau, Melcior Riera, Manuel Crespo, Jordi Navarro, Eva Van Den Eynde, Ana Maria Planes, Esteban Ribera, Albert Pahissa, Vicenç Falcó

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Background: Few data exist on the implications of widespread use of 7-valent pneumococcal conjugate vaccine in children in the invasive pneumococcal disease (IPD) in HIV-infected adults. We conducted a multicenter study to analyze differences in clinical presentation of IPD between HIV-infected and non-HIV-infected adults in the prevaccine and postvaccine era. Methods: Study of all cases of IPD in HIV-infected adults diagnosed since 1996 to 2010. Episodes were classified into prevaccine (1996-2001), early postvaccine (2002-2004), and late postvaccine period (2005-2010). For each case, we identified an HIV-negative control patient with IPD matched by hospital, age, and vaccine period. RESULTS: Two hundred twenty-one episodes of IPD in HIV-infected patients were diagnosed. The incidence of IPD decreased from 7.81 to 3.69 episodes per 1000 patient-years (-53%; 95% confidence interval:-65% to-36%, P < 0.001) between prevaccine and late postvaccine period. There was an 81% (95% confidence interval:-88% to-69%, P < 0.001) decrease of IPD caused by vaccine serotypes. In late postvaccine period IPD in HIV-infected patients was associated to higher rates of respiratory failure (28.4% vs. 48.4%, P = 0.011), greater intensive care unit admission (8.2% vs. 21.7%, P = 0.02) and a higher need for mechanical ventilation (5.9% vs. 16.3%, P = 0.033). In the prevaccine period, non-HIV-infected patients had a more severe illness than in those with HIV infection; however, these differences disappeared in the late postvaccine period. Conclusions: In the late postvaccine era, the incidence of IPD in HIV-infected patients has decreased, however, clinical presentation seems to have changed to a more severe illness. The widespread use of highly active antiretroviral therapy, polyssacharide vaccine, and 7-valent pneumococcal conjugate vaccine has contributed to these changes.
Original languageEnglish
Pages (from-to)31-38
JournalJournal of acquired immune deficiency syndromes (1999)
Issue number1
Publication statusPublished - 1 Jan 2012


  • HIV-infected patients
  • invasive pneumococcal disease
  • pneumococcal conjugated vaccine
  • Streptococcus pneumonia


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