 |
|
|
| |
Invasive Pneumococcal Disease Rate 17-Fold Higher With HIV in US
|
| |
| |
IDWeek, September 29-October 3, 2021
Mark Mascolini
Rates of invasive pneumococcal disease (IPD) in the United States remain 17-fold higher in people with than without HIV, despite introduction of the 13-valent pneumococcal conjugate vaccine (PCV13) and the 23-valent polysaccharide vaccine (PPSV23) [1]. But IPD incidence fell sharply from 2008-2009 to 2017-2018 in people with and without HIV, according to this nationwide study by the Centers for Disease Control and Prevention (CDC) and academic collaborators.
Streptococcus pneumoniae-or pneumococcus-can cause infections ranging from pneumonia and bacteremia to meningitis and sinusitis [2]. Pneumococcal disease becomes IPD when the bacterium invades usually pneumococcus-free parts of the body; that invasion often causes severe disease requiring hospital care. The CDC recommends both PCV13 and PPSV23 for people with HIV [3]. The 15-valent and 20-valent conjugate vaccines (PCV15 and PCV20) are also now licensed for adults in the United States.
Researchers identified IPD cases in people at least 19 years old through the CDC's Active Bacterial Core surveillance (ABCs) and determined HIV status through medical records. They grouped pneumococcal isolates into (1) PVC13 types (recognized by the 13-valent pneumococcal conjugate vaccine or PCV13), (2) PPV11 types (recognized by the 23-valent polysaccharide vaccine or PPSV23), and (3) nonvaccine types.
The investigators estimated IPD incidence (new cases per 100,000 people) by making the numerator national projections of ABCs cases and the denominator (1) national case-based HIV surveillance data for people with HIV in ABCs catchment areas or (2) for the HIV-negative group, the population of ABCs in catchment area minus the number of people with HIV in ABCs catchment area. Then the researchers compared IPD incidence in 2008-2009 (before PCV13 became available) with IPD incidence in two later periods, 2011-2012 (when PCV13 got recommended for immunocompromised adults) and 2017-2018.
Over the whole study period (2008-2018), 29,668 IPD cases were counted at 9 ABCs sites, of whom 2440 (8.2%) had known HIV infection. IPD patients with versus without HIV were younger (median age 47 vs 61 years), more likely male (63.4% vs 51.4%), and more likely non-Hispanic black (68.4% vs 17.6%).
Initial 2008-2009 IPD incidence was 20-fold higher in the HIV group (306.7 per 100,000 people) than in the HIV-negative group (15.2 per 100,000). By 2017-2018 IPD incidence fell 40% in people with HIV (-40.3%, 95% confidence interval [CI] -47.7% to -32.3%) and 28% in people without HIV (-28.2% 95% CI -30.9 to -25.5%). In both 2011-2012 and 2017=2018, the biggest IPD drops involved PCV13-type IPD: in 2011-2012, -44.2% for people with HIV and -42.2% for people without HIV in 2011-2012; and in 2017-2018, -72.5% for people with HIV and -62.2% for people without HIV in 2017-2018.
In 2017-2018 overall IPD incidence was 17 times higher with than without HIV (16.8, 95% CI 15.1 to 18.5), and PCV13 IPD rates were more than 12 times higher with than without HIV (12.6, 95% CI 9.9 to 15.3).
The investigators concluded that falling IPD incidence in adults with and without HIV over the study period mainly reflected declines in PCV13-type IPD. But non-PCV13 types kept overall IPD rates 17-fold higher with than without HIV in the latest study period. The researchers suggested that newly licensed higher-valency pneumococcal conjugate vaccines could help reduce the higher IPD incidence in people with HIV.
References
1. Matanock A, Li J, Adih W, et al. Changes in invasive pneumococcal disease among adults living with HIV following introduction of 13-valent pneumococcal conjugate vaccine, 2008-2018. IDWeek, September 29-October 3, 2021. Abstract 70.
2. Centers for Disease Control and Prevention. Pneumococcal disease. Types of infection. https://www.cdc.gov/pneumococcal/about/infection-types.html
3. Centers for Disease Control and Prevention. HIV Infection and adult vaccination. https://www.cdc.gov/vaccines/adults/rec-vac/health-conditions/hiv.html
|
| |
|
|
|
|
|
