Clinical, epidemiological and preventative aspects

Abstract
The pneumococcus (Streptococcus pneumoniae) is a leading cause of morbidity and mortality in tropical and temperate climes. Despite being well recognized as an important pathogen associated with human immunodeficiency virus (HIV) infection in industrialized countries, this interaction has received little attention in Africa. Work on this subject carried out in Nairobi (Kenya) over a period of 5 years (1989–1993) is reviewed. Among epidemiological aspects, nasopharyngeal carriage is discussed and the increased risks for invasive disease and pneumococcal pneumonia, recorded in cross-sectional and prospective studies, are highlighted. Clinical aspects include the wider spectrum of HIV-related invasive pneumococcal disease that is seen in adults, emphasizing that, even with high rates of penicillin resistance, standard benzylpenicillin therapy is effective if started early in disease. Many patients, however, present late in the course of illness and mortality rates for pneumococcal pneumonia are higher in HIV-infected adults. Pneumococcal disease is preventable in immunocompetent adults and, although no efficacy data are available, vaccination is recommended for all HIV-infected adults in industrialized countries. Current research investigating the efficacy of pneumococcal vaccination in HIV-infected adults living in Entebbe (Uganda) and clients of The AIDS [acquired immune deficiency syndrome] Support Organization (TASO) is summarized. The results of this ‘double-blind’ placebo-controlled trial will be known in July 1998.