TY - JOUR
T1 - Incidence and Risk Factors for Invasive Pneumococcal Disease in HIV-infected and non-HIV infected Individuals Before and After the Introduction of Combination Antiretroviral Therapy
T2 - Persisting High Risk among HIV-infected Injecting Drug Users
AU - Harboe, Zitta Barrella
AU - Larsen, Mette Vang
AU - Ladelund, Steen
AU - Kronborg, Gitte
AU - Konradsen, Helle Bossen
AU - Gerstoft, Jan
AU - Larsen, Carsten Schade
AU - Pedersen, Court
AU - Pedersen, Gitte
AU - Obel, Niels
AU - Benfield, Thomas
N1 - © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.
PY - 2014/7/17
Y1 - 2014/7/17
N2 - BACKGROUND: Invasive pneumococcal disease (IPD) is an important cause of morbidity among HIV-infected individuals. We described incidence and risk factors for IPD in HIV-infected and uninfected individuals.METHODS: Nationwide population-based cohort study of HIV-infected adults treated at all Danish HIV-treatment centers during 1995-2012. Nineteen population-matched controls per HIV-infected individual were retrieved. The risk of IPD (RR, [95% CI]) was assessed using Poisson regression.RESULTS: The incidence of IPD was 304.7 cases/100,000 PYFU in HIV-infected and 12.8/100,000 PYFU in HIV-uninfected individuals. After adjusting for confounders, HIV-infection (RR 24.4 [23.7-25.1]), male sex (RR 1.20 [1.16-1.24]), increasing age (per year) (RR 1.03 [1.03-1.04]) and calendar period (pre-cART [RR 2.80 [2.70-2.91] compared to late cART) were significantly associated with an increased risk of IPD. Among HIV-infected individuals, male sex (RR 1.57 [1.49-1.66]), smoking (RR 1.34 [1.26-1.42]), and intravenous drug use (RR 2.51 [2.26-2.67]) were associated with an increased risk of IPD. Detectable viral loads (RR 1.88 [1.79-1.98]) and a relative fall in CD4 T-cell counts were also associated with an increased risk (≥500 to 350-<500 CD4 T-cells/µl RR 1.29 [1.21-1.37], and <100 cells/µl RR 7.4 [6.87-8.02]). The risk of IPD declined over time though this was not the case for IDUs where the risk remained unchanged.CONCLUSIONS: The incidence of IPD in HIV-infected individuals remained significantly higher than the incidence observed in non-HIV-infected, in spite of the widespread use of cART. IDUs have a persisting high risk of IPD. IDU, smoking, the receipt of cART are suitable targets for preventive measures in the future.
AB - BACKGROUND: Invasive pneumococcal disease (IPD) is an important cause of morbidity among HIV-infected individuals. We described incidence and risk factors for IPD in HIV-infected and uninfected individuals.METHODS: Nationwide population-based cohort study of HIV-infected adults treated at all Danish HIV-treatment centers during 1995-2012. Nineteen population-matched controls per HIV-infected individual were retrieved. The risk of IPD (RR, [95% CI]) was assessed using Poisson regression.RESULTS: The incidence of IPD was 304.7 cases/100,000 PYFU in HIV-infected and 12.8/100,000 PYFU in HIV-uninfected individuals. After adjusting for confounders, HIV-infection (RR 24.4 [23.7-25.1]), male sex (RR 1.20 [1.16-1.24]), increasing age (per year) (RR 1.03 [1.03-1.04]) and calendar period (pre-cART [RR 2.80 [2.70-2.91] compared to late cART) were significantly associated with an increased risk of IPD. Among HIV-infected individuals, male sex (RR 1.57 [1.49-1.66]), smoking (RR 1.34 [1.26-1.42]), and intravenous drug use (RR 2.51 [2.26-2.67]) were associated with an increased risk of IPD. Detectable viral loads (RR 1.88 [1.79-1.98]) and a relative fall in CD4 T-cell counts were also associated with an increased risk (≥500 to 350-<500 CD4 T-cells/µl RR 1.29 [1.21-1.37], and <100 cells/µl RR 7.4 [6.87-8.02]). The risk of IPD declined over time though this was not the case for IDUs where the risk remained unchanged.CONCLUSIONS: The incidence of IPD in HIV-infected individuals remained significantly higher than the incidence observed in non-HIV-infected, in spite of the widespread use of cART. IDUs have a persisting high risk of IPD. IDU, smoking, the receipt of cART are suitable targets for preventive measures in the future.
U2 - 10.1093/cid/ciu558
DO - 10.1093/cid/ciu558
M3 - Journal article
C2 - 25038114
SN - 1058-4838
VL - 59
SP - 1168
EP - 1176
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 8
ER -