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1 October 2007

Volume 45, Number 7
Clinical Infectious Diseases 2007;45:e82–e87
© 2007 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2007/4507-00E1$15.00
DOI: 10.1086/520977
MAJOR ARTICLE

Effectiveness of Polysaccharide Pneumococcal Vaccine in HIV‐Infected Patients: A Case‐Control Study

Maria Peñaranda,1

Vicenç Falco,4

Antoni Payeras,2

Queralt Jordano,3

Adria Curran,4

Antoni Pareja,2

Gloria Samperiz,1

David Dalmau,3

Esteve Ribera,4 and

Melcior Riera1

1Hospital Son Dureta, 2Hospital Son Llatzer, and 3Mutua de Terrasa, Palma de Mallorca, and 4Hospital Vall d’Hebron, Barcelona, Spain

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.

Received 20 February 2007; accepted 16 May 2007; electronically published 21 August 2007.

Reprints or correspondence: Dr. Maria Peñaranda Vera, Infectious Diseases Unit, Hospital Son Dureta, Andrea Doria, n. 55, 07084, Palma de Mallorca, Spain ().

Cited by

Laurence HUANG, Kristina CROTHERS. (2009) HIV-associated opportunistic pneumonias. Respirology 14:4, 474-485
Online publication date: 1-Jun-2009.
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Giordano Madeddu, Alessandro Giuseppe Fois, Pietro Pirina, Maria Stella Mura. (2009) Pneumococcal pneumonia: clinical features, diagnosis and management in HIV-infected and HIV noninfected patients. Current Opinion in Pulmonary Medicine 15:3, 236-242
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A Curran, V Falcó, M Crespo, X Martinez, E Ribera, S Villar del Saz, A Imaz, E Coma, A Ferrer, A Pahissa. (2008) Bacterial pneumonia in HIV-infected patients: use of the pneumonia severity index and impact of current management on incidence, aetiology and outcome. HIV Medicine 0:0, 080616221653485-???
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J Lucian Davis, Matthew Fei, Laurence Huang. (2008) Respiratory infection complicating HIV infection. Current Opinion in Infectious Diseases 21:2, 184-190
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