Epidemiologic Relation between HIV and Invasive Pneumococcal Disease in San Francisco County, California

  1. J. Pekka Nuorti, MD;
  2. Jay C. Butler, MD;
  3. Lisa Gelling, MPH;
  4. Jacob L. Kool, MD, MS;
  5. Arthur L. Reingold, MD; and
  6. Duc J. Vugia, MD, MPH
  1. From the California State Department of Health Services, California Emerging Infections Program, and the University of California at Berkeley, Berkeley, California; and the National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.

    Abstract

    Background: Patients with AIDS have a high incidence of invasive pneumococcal disease, but no population-based data are available on secular trends or rates of this disease in specific demographic groups.

    Objective: To compare clinical characteristics, rates, and trends of pneumococcal disease in HIV-infected and non-HIV-infected persons.

    Design: Population-based laboratory surveillance and chart review.

    Setting: All of the 13 microbiology laboratories in San Francisco County, California.

    Patients: Persons who had a sterile site culture that was positive for Streptococcus pneumoniae between October 1994 and June 1997.

    Measurements: Stratified incidence rates and adjusted rate ratios, serotyping of isolates, and comparison of secular trends and rates according to census tract by Poisson regression.

    Results: Persons infected with HIV accounted for 54.2% of 399 patients 18 to 64 years of age who had pneumococcal disease. The incidence of pneumococcal disease per 100 000 person-years was 35.0 cases overall and 802.9 cases in patients with AIDS. Compared with persons who were not known to be HIV-infected, the rate ratio for patients with AIDS was 46.0 (95% CI, 36.0 to 58.9); 55.2% of cases were attributable to HIV. In HIV-infected patients, 82.5% of isolates were serotypes that are included in the pneumococcal polysaccharide vaccine. The incidence of pneumococcal disease in black patients with AIDS (2384.6 cases per 100 000 person-years) was 5.4 times that in nonblack patients with AIDS. Rates by census tract were inversely associated with income (P < 0.001). During the study period, the incidence of pneumococcal disease decreased from 10.6 cases per 1000 person-years to 4.2 cases per 1000 person-years in patients with AIDS (P = 0.004, Poisson regression).

    Conclusions: In a community with a high prevalence of HIV infection, much of the burden of pneumococcal disease was attributable to AIDS. High incidence rates were seen in young adults and especially in black persons. Efforts to increase pneumococcal vaccination rates should target HIV-infected adults, particularly those living in poor urban areas.

    Article and Author Information

    • Note: This paper was presented in part at the 35th Annual Meeting of the Infectious Disease Society of America, San Francisco, California, 13-16 September 1997.

    • Grant Support: Pneumococcal surveillance was funded by the National Center for Infectious Diseases Emerging Infections Program and the National Vaccine Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia.

    • Acknowledgments: The authors thank the following persons for their assistance in the investigation: Ling Hsu, San Francisco Department of Public Health, AIDS Office, San Francisco, California; Gretchen Rothrock, California Emerging Infections Program, Berkeley, California; Richard Facklam, Robert Breiman, Margarette Kolczak, Ariane Kraus, David Keller, Brian Plikaytis, and Anne Schuchat, Centers for Disease Control and Prevention, Atlanta, Georgia.

    • Requests for Single Reprints: J. Pekka Nuorti, MD, Department of Infectious Disease Epidemiology, National Public Health Institute, Mannerheimintie 166, FIN-00300 Helsinki, Finland; e-mail, pekka.nuorti{at}ktl.fi.

    • Requests To Purchase Bulk Reprints (minimum, 100 copies): the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints{at}mail.acponline.org.

    • Current Author Addresses: Dr. Nuorti: Department of Infectious Disease Epidemiology, National Public Health Institute, Mannerheimintie 166, FIN-00300 Helsinki, Finland.

    • Dr. Butler: Arctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, 4055 Tudor Centre Drive, Anchorage, AK 99508-5902.

    • Ms. Gelling: California Emerging Infections Program, 703 Market Street, Suite 705, San Francisco, CA 94103.

    • Dr. Kool: Department of Infectious Disease Epidemiology (CIE), RIVM, Postbak 75, A van Leeuwenhoeklaan 9, 3720 BA Bilthoven, the Netherlands.

    • Dr. Reingold: Division of Public Health Biology and Epidemiology, Earl Warren Hall, University of California, Berkeley, Berkeley, CA 94720-7360.

    • Dr. Vugia: Division of Communicable Disease Control, State of California, Department of Health Services, 2151 Berkeley Way, Berkeley, CA 94704-1011.

    • Author Contributions: Conception and design: J.P. Nuorti, A. Reingold, D.J. Vugia.

    • Analysis and interpretation of the data: J.P. Nuorti, J.C. Butler, J.L. Kool, D.J. Vugia.

    • Drafting of the article: J.P. Nuorti, J.C. Butler.

    • Critical revision of the article for important intellectual content: J.P. Nuorti, J.C. Butler, J.L. Kool, A. Reingold, D.J. Vugia.

    • Final approval of the article: J.P. Nuorti, J.C. Butler, L.B. Gelling, J.L. Kool, A. Reingold, D.J. Vugia.

    • Statistical expertise: J.P. Nuorti, J.C. Butler, J.L. Kool.

    • Obtaining of funding: A. Reingold, D.J. Vugia.

    • Administrative, technical, or logistic support: J.C. Butler, L.B. Gelling, A. Reingold, D.J. Vugia.

    • Collection and assembly of data: J.P. Nuorti, L.B. Gelling, D.J. Vugia.

    Summary for Patients

    • Summaries for Patients:Human Immunodeficiency Virus (HIV) and Invasive Pneumococcal Infections Ann Intern Med February 1, 2000 132:182
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    1. Ann Intern Med February 1, 2000 vol. 132 no. 3 182-190
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