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

Tropical Medicine and Infectious Disease

article

Roxana Flores Mamani¹  Tiago de Assunção López²  Waldir Madany Jalo¹  Marcelo Ribeiro Alves¹  Estevão Portela Nunes¹  Mario Sérgio Pereira¹  Erica Aparecida dos Santos Ribeiro da Silva¹  Maria Cristina da Silva Lourenço¹  Valdiléa Gonçalves Veloso¹  Beatriz Jegerhorn Grinsztejn¹  Sandra Wagner Cardoso¹  Cristiane da Cruz Lamas¹ 

[1] Instituto Nacional de Infectologia Evandro Chagas;Barra da Tijuca Campus, Department of Medicine, Universidade do Grande Rio/Afya;Instituto Nacional de Cardiologia

关键词: HIV/AIDS;    Streptococcus pneumoniae;    pneumococcus;    invasive pneumococcal disease;    vaccination;    Brazil;   

DOI  :  10.3390/tropicalmed8060328

学科分类：社会科学、人文和艺术（综合）

来源: mdpi

【 摘 要 】

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.

【 授权许可】

CC BY