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. 2023 Jun 19;8(6):328.
doi: 10.3390/tropicalmed8060328.

Invasive Pneumococcal Disease in People Living with HIV: A Retrospective Case-Control Study in Brazil

Roxana Flores Mamani  1 , Tiago de Assunção López  2 , Waldir Madany Jalo  1 , Marcelo Ribeiro Alves  1 , Estevão Portela Nunes  1 , Mario Sérgio Pereira  1 , Erica Aparecida Dos Santos Ribeiro da Silva  1 , Maria Cristina da Silva Lourenço  1 , Valdiléa Gonçalves Veloso  1 , Beatriz Jegerhorn Grinsztejn  1 , Sandra Wagner Cardoso  1 , Cristiane da Cruz Lamas  1   3
Affiliations

Invasive Pneumococcal Disease in People Living with HIV: A Retrospective Case-Control Study in Brazil

Roxana Flores Mamani et al. Trop Med Infect Dis. .

Abstract

HIV-infected patients are at particular risk for invasive pneumococcal disease (IPD). We describe cases of IPD in people living with HIV/AIDS (PLWHA) and find associated risk factors for infection and death.

Methods: A retrospective case-control study, nested in a cohort, including PLWHA with and without IPD, conducted in Brazil, 2005-2020. Controls were of the same gender/age and seen at the same time/place as cases.

Results: We identified 55 episodes of IPD (cases) in 45 patients and 108 controls. The incidence of IPD was 964/100,000 person-years. A total of 42 of 55 (76.4%) IPD episodes presented with pneumonia and 11 (20%) with bacteremia without a focus and 38/45 (84.4%) were hospitalized. Blood cultures were positive in 54/55 (98.2%). Liver cirrhosis and COPD were the only factors associated with IPD in PLWHA in univariate analysis, although no associated factors were found in multivariate analysis. Penicillin resistance was found in 4/45 (8.9%). Regarding antiretroviral therapy (ART), 40/45 (88.9%) cases vs. 80/102 controls (74.1%) were in use (p = 0.07). Patients with HIV and IPD had a higher CD4 count of 267 cells/mm3 compared with the control group, in which it was 140 cells/mm3 (p = 0.027). Pneumococcal vaccination was documented in 19%. Alcoholism (p = 0.018), hepatic cirrhosis (p = 0.003), and lower nadir CD4 count (p = 0.033) were associated with the risk of death in patients with IPD. In-hospital mortality among PLWHA and IPD was 21.1%, and it was associated with thrombocytopenia and hypoalbuminemia, elevated band forms, creatinine, and aspartate aminotransferase (AST).

Conclusions: The incidence of IPD in PLWHA remained high despite ART. The vaccination rate was low. Liver cirrhosis was associated with IPD and death.

Keywords: Brazil; HIV/AIDS; Streptococcus pneumoniae; invasive pneumococcal disease; pneumococcus; vaccination.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The annual incidence of IPD in PLWHA/100,000 person-years in Rio de Janeiro, Brazil, in 2005–2020.
See this image and copyright information in PMC

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