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Despite ART, HIV patients in Denmark have higher rates of IPD
Despite use of combination antiretroviral therapy, patients with HIV continue to have a higher prevalence of invasive pneumococcal disease than those without HIV, according to recent findings.
“The widespread use of [ART] during the last decades has changed the epidemiology of [invasive pneumococcal disease (IPD)] in HIV-infected patients,” researchers wrote in Clinical Infectious Diseases.
In a nationwide population cohort study, the researchers evaluated patients with HIV seen at treatment facilities in Denmark between 1995 and 2012. The data were collected through a linkage of national laboratory surveillance of IPD, the Danish HIV Cohort Study (DHCS) and the Danish Civil Registration System. The study included 19 matched controls for each patient with HIV. The researchers estimated rates of IPD in three different periods: 1995 to 1996 (pre-ART); 1997 to 1999 (early-ART) and 2000 to 2012 (late-ART).
The study included 5,362 patients with HIV and 101,869 matched controls. Overall, the incidence of IPD was 304.7 cases per 100,000 person-years of follow-up (PYFU) in patients with HIV, and 12.8 cases per 100,000 PYFU in matched-controls. The IPD incidence declined significantly in both groups from the pre-ART era to the late-ART era.
The researchers found significant associations between increased IPD risk and the following: HIV infection (relative risk [RR]=24.4; 95% CI, 23.7-25.1), male gender (RR=1.20; 95% CI, 1.16-1.24), increasing age per year (RR=1.03; 95% CI, 1.03-1.04]) and time period (ie, pre-ART vs. late ART; RR=2.80; 95% CI, 2.70-2.91).
In patients with HIV, increased risk of IPD was associated with the following: male gender (RR=1.57; 95% CI, 1.49-1.66) smoking (RR=1.34; 95% CI, 1.26-1.42) and IV drug use (RR=2.51; 95% CI, 2.26-2.67). Additionally, detectable viral loads (RR=1.88; 95% CI, 1.79-1.98) and low CD4 counts (350-499 cells/mcL [RR=1.29; 95% CI, 1.21-1.37]; 100-349 cells/mcL [RR=2.81; 95% CI, 2.66-2.97]; and <100 cells/mcL [RR=7.4; 95% CI, 6.87-8.02]), were related to increased IPD risk.
Although the risk of IPD decreased over time, this decrease did not apply to IV drug users, whose risk remained constant. No patients among the matched-controls experienced an IPD recurrence, whereas 13 patients with HIV had at least one recurrence
“The incidence of IPD in HIV-infected individuals remained significantly higher than the incidence observed in HIV-uninfected individuals, in spite of the widespread use of ART in Denmark,” the researchers wrote. “[IV drug users] have a remarkably high risk of IPD that hasn’t declined over time, and remain an obvious group for targeted immunization because pneumococcal vaccination… Injecting drug use, smoking and the receipt of ART are suitable targets for preventive measures in the future.”
Disclosure: Please see the full study for a list of relevant disclosures.