Journal Article

Effectiveness of Polysaccharide Pneumococcal Vaccine in HIV-Infected Patients: a Case-Control Study

Maria Peñaranda, Vicenç Falco, Antoni Payeras, Queralt Jordano, Adria Curran, Antoni Pareja, Gloria Samperiz, David Dalmau, Esteve Ribera and Melcior Riera

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 45, issue 7, pages e82-e87
Published in print October 2007 | ISSN: 1058-4838
Published online October 2007 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/520977
Effectiveness of Polysaccharide Pneumococcal Vaccine in HIV-Infected Patients: a Case-Control Study

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Background. Polysaccharide pneumococcal vaccine (PPV) is recommended among human immunodeficiency virus (HIV)–infected patients, although its effect in reducing the incidence of pneumonia or invasive pneumococcal disease is not well established. Our objective was to determine the effectiveness of 23-valent PPV in HIV-infected adults and the risk factors for pneumococcal pneumonia or invasive pneumococcal disease.

Methods. We performed a retrospective case-control study in 4 Spanish hospitals for the period from January 1995 through December 2005 using the HIV database from each hospital to identify case patients with Streptococcus pneumoniae disease and control subjects without a history of pneumococcal infection.

Results. A total of 184 case patients and 552 control subjects were identified. The factors associated with pneumococcal disease in bivariate analysis were active injection drug use (odds ratio [OR], 3.33; 95% confidence interval [CI], 2–5.55), alcoholism (OR, 3.03; 95% CI, 1.86–4.91), chronic obstructive pulmonary disease (OR, 2.58; 95% CI, 1.3–5.1), cirrhosis (OR, 6.05; 95% CI, 3.2–11.4), antiretroviral therapy (OR, 0.23; 95% CI, 0.16–0.32), trimethoprim-sulfamethoxazole prophylaxis (OR, 0.66; 95% CI, 0.45–0.97), viral load <5000 copies/mL (OR, 0.38; 95% CI, 0.26–0.54), and previous PPV (OR, 0.39; 95% CI, 0.24–0.65). Risk factors for pneumococcal disease in multivariate analysis were cirrhosis (OR, 5.64; 95% CI, 2.53–12.53), chronic obstructive pulmonary disease (OR, 2.90; 95% CI, 1.21–6.94), and alcoholism (OR, 2.15; 95% CI, 1.11–4.19), whereas protective factors were receipt of antiretroviral therapy (OR, 0.23; 95% CI, 0.14–0.36) and receipt of pneumococcal vaccine (OR, 0.44; 95% CI, 0.22–0.88), even in patients with CD4 lymphocyte counts <200 cells/µL.

Conclusions. Antiretroviral therapy and PPV have a significant, independent protective effect against pneumococcal disease, regardless of CD4 lymphocyte count; thus, all patients with HIV infection should be vaccinated with PPV to prevent pneumococcal disease.

Journal Article.  3656 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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