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

Roxana Flores Mamani; Tiago de Assunção López; Waldir Madany Jalo; Marcelo Ribeiro Alves; Estevão Portela Nunes; Mario Sérgio Pereira; Erica Aparecida Dos Santos Ribeiro da Silva; Maria Cristina da Silva Lourenço; Valdiléa Gonçalves Veloso; Beatriz Jegerhorn Grinsztejn; Sandra Wagner Cardoso; Cristiane da Cruz Lamas

doi:10.3390/tropicalmed8060328

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

Trop Med Infect Dis. 2023 Jun 19;8(6):328. doi: 10.3390/tropicalmed8060328.

Authors

Affiliations

¹ Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Avenida Brasil 4365-Manguinhos, Rio de Janeiro 21040-360, RJ, Brazil.
² Barra da Tijuca Campus, Department of Medicine, Universidade do Grande Rio/Afya, Avenida Ayrton Senna, 2.200, Barra da Tijuca 22775-003, RJ, Brazil.
³ Instituto Nacional de Cardiologia, Rua das Laranjeiras, 374-Laranjeiras, Rio de Janeiro 22240-006, RJ, Brazil.

Abstract

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.

Keywords: Brazil; HIV/AIDS; Streptococcus pneumoniae; invasive pneumococcal disease; pneumococcus; vaccination.

Grants and funding

Dr. Grinsztejn acknowledges funding from the National Council of Technological and Scientific Development (CNPq) and the Research Funding Agency of the State of Rio de Janeiro (FAPERJ).