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. 2016 Dec 20;3(4):ofw228.
doi: 10.1093/ofid/ofw228. eCollection 2016 Oct.

Antiretroviral Therapy as Prevention of … Pneumococcal Infections?

Anaïs Lesourd  1 , Jérémie Leporrier  1 , Valérie Delbos  2 , Guillemette Unal  2 , Patricia Honoré  3 , Manuel Etienne  2 , Olivier Bouchaud  3 , François Caron  2
Affiliations

Antiretroviral Therapy as Prevention of … Pneumococcal Infections?

Anaïs Lesourd et al. Open Forum Infect Dis. .

Erratum in

  • Erratum.
    [No authors listed] [No authors listed] Open Forum Infect Dis. 2017 Jun 29;4(2):ofx010. doi: 10.1093/ofid/ofx010. eCollection 2017 Spring. Open Forum Infect Dis. 2017. PMID: 28680901 Free PMC article.

Abstract

Background: Despite antiretroviral therapy, it is generally believed that the risk for pneumococcal infections (PnIs) is high among patients infected with human immunodeficiency virus (HIV). However, most studies in this field have been conducted before 2010, and the proportion of virologically suppressed patients has drastically increased in these latter years thanks to larger indications and more effective antiretroviral regimens. This study aimed to re-evaluate the current risk of PnI among adult patients infected with HIV.

Methods: The incidence of PnI was evaluated between 1996 and 2014 in 2 French regional hospitals. The 80 most recent cases of PnI (2000-2014) were retrospectively compared with 160 controls (HIV patients without PnI) to analyze the residual risk factors of PnI.

Results: Among a mean annual follow-up cohort of 1616 patients, 116 PnIs were observed over 18 years. The risk factors of PnI among patients infected with HIV were an uncontrolled HIV infection or "classic" risk factors of PnI shared by the general population such as addiction, renal or respiratory insufficiency, or hepatitis B or C coinfection. Pneumococcal vaccination coverage was low and poorly targeted, because only 5% of the cases had been previously vaccinated. The incidence of invasive PnIs among HIV patients with a nonvirologically suppressed infection or comorbidities was 12 times higher than that reported in the general population at the country level (107 vs 9/100000 patients), whereas the incidence among virologically suppressed HIV patients without comorbidities was lower (7.6/100000 patients).

Conclusions: Human immunodeficiency virus infection no longer per se seems to be a significant risk factor for PnI, suggesting a step-down from a systematic to an "at-risk patient" targeted pneumococcal vaccination strategy.

Keywords: HIV; Streptococcus pneumoniae; pneumococcal infections; risk factors; vaccination.

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Figures

Figure 1.
Figure 1.
Cross-evolution of the incidence of pneumococcal infections and rate of patients with an undetectable viral load and CD4 T cells >500/mm3 in the Rouen human immunodeficiency virus (HIV) cohort (data unavailable for all years in Avicenne).
See this image and copyright information in PMC

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