LETTER
Pneumococcal Disease and HIV Infection
Charles F. Gilks
1 March 1993 | Volume 118 Issue 5 | Pages 393-394
TO THE EDITOR:
Janoff and colleagues [1] are to be congratulated on a clear and comprehensive review of the importance of the interaction of HIV infection with Streptococcus pneumoniae. Despite the extent of pneumococcal infection worldwide and its associated mortality and morbidity at all ages, only a few such studies (mostly small or retrospective) have been published.
Pneumococcal infection is particularly important in Africa, where HIV infection is so prevalent. We have been studying high-grade (nonopportunistic) bacterial infections in Nairobi for several years. Streptococcus pneumoniae is the leading cause of bacteremia in HIV-seronegative adults admitted to the hospital and is strongly associated with HIV infection [2].
In a large cohort of lower socioeconomic class female prostitutes in Nairobi during a 2-year period, we found that invasive pneumococcal disease was the most frequently encountered serious HIV-associated infection, even more common than tuberculosis [3]. As expected, disease presentation was early (mean CD4 count, 325/mm3), and many women (22%) developed reinfection. Under the optimal conditions of a community-based research clinic, no patients died despite the fact that 29 episodes were bacteremic. In a more typical general hospital setting, however, mortality from pneumococcal pneumonia may be higher in HIV-infected adults [4].
Few studies in Africa have investigated comprehensively the clinical problems of the HIV-infected adult. Because of insufficient bacteriology laboratories, the interaction with the pneumococcus, as well as with non-typhi salmonellae, has therefore largely been missed [5]. Yet, these pathogens are treatable with readily available and affordable antibiotics.
The authoritative review by Janoff and colleagues may help to increase awareness of the importance of the pneumococcus globally and may stimulate much needed research into both disease and prevention. The pneumococcus remains the only important HIV-associated pathogen for which an effective and licensed vaccine is available. The question remains: Will it work in Africa?
1. Janoff EN, Breiman RF, Daley CL, Hopewood PC. Pneumococcal disease during HIV infection. Epidemiologic, clinical and immunologic perspectives. Ann Intern Med. 1992; 117:314-24.
2. Gilks CF, Brindle RJ, Otieno LS, Simani PS, Newnham RS, Bhatt SM, et al. Life-threatening bacteraemia in HIV-1 seropositive adults admitted to hospital in Nairobi, Kenya. Lancet. 1990; 336:545-9.
3. Gilks CF, Ojoo S, Paul J, Brindle R, Batchelor R, Kimari J, et al. Pneumococcal disease in a cohort of low-class HIV-1 seropositive Nairobi prostitutes (Abstract POB 3555). Eighth International Conference on AIDS. Amsterdam, the Netherlands. 19 to 24 July 1992.
4. Simani P, Gilks C, Brindle R, Otieno L, Okello G, Ndinya-Achola J, et al. The role of pneumococcal disease among HIV seropositive and seronegative patients with acute pneumonia in Nairobi, Kenya (Abstract POB 3899). Eighth International Conference on AIDS. Amsterdam, the Netherlands. 19 to 24 July 1992.
5. Gilks CF, Ojoo SA, Brindle RJ. Non-opportunistic bacterial infections in HIV-seropositive adults in Nairobi, Kenya. AIDS 1991; 5(Suppl 1):S113-6.
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