Invasive pneumococcal disease in a cohort of HIV-infected adults: incidence and risk factors, 1990–2003

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Abstract
Objective: To investigate the association between the introduction of HAART and invasive pneumococcal disease (IPD) in HIV-infected patients. Methods: Incidence of IPD was determined from 1990 to 2003 in a cohort of HIV-infected individuals and a nested case–control study assessed risk factors of IPD. Results: There were 72 cases over 19 020 person-years of follow-up (overall IPD rate, 379/100 000 person-years). In the calendar periods 1990–1995, 1995–1998, and 1998–2003, the IPD incidence per 100 000 person-years was 279 [95% confidence interval (CI), 150–519], 377 (95% CI, 227–625) and 410 (95% CI, 308–545), respectively (P = 0.516). CD4 cell count < 200 cells/μl [odds ratio (OR), 3.0; 95% CI, 1.2–7.6), HIV RNA > 50 000 copies/ml (OR, 2.8; 95% CI, 1.2–6.5), hepatitis C (OR, 4.9; 95% CI, 1.7–14.9), serum albumin (OR, 0.1; 95% CI, 0.04–0.5), injection drug use in women (OR, 3.8; 95% CI, 1.6–8.8), and education beyond high school (OR, 0.2; 95% CI, 0.05–0.8) were significantly associated with IPD in multivariate analysis. No treatment factor, including HAART (OR, 0.7; 95% CI, 0.3–1.5) and pneumococcal vaccination (OR, 0.9; 95% CI, 0.5–1.6), was associated with IPD. Conclusions: IPD incidence did not change significantly during the widespread dissemination of HAART in this cohort. IPD risk was associated with several sociodemographic and clinical factors.

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