Persistent
High Burden of Invasive Pneumococcal Disease in South African
HIV-Infected Adults in the Era of an Antiretroviral Treatment Program
Nunes
MC
,
von Gottberg
A
,
de Gouveia
L
,
Cohen
C
,
Kuwanda
L
,
et al. 2011
Persistent High Burden of Invasive
Pneumococcal Disease in South African HIV-Infected Adults in the Era of
an Antiretroviral Treatment Program.
PLoS ONE 6(11):
e27929.
doi:10.1371/journal.pone.0027929
Background. Highly active antiretroviral treatment (HAART) programs have been associated with declines in the burden of invasive pneumococcal disease
(IPD) in industrialized countries. The aim of this study was to
evaluate trends in IPD hospitalizations in HIV-infected adults in
Soweto, South Africa, associated with up-scaling of the HAART program
from 2003 to 2008.
Methods. Laboratory-confirmed
IPD cases were identified from 2003 through 2008 through an existing
surveillance program. The period 2003-04 was designated as the
early-HAART era, 2005–06 as the intermediate-HAART era and 2007–08 as
the established-HAART era. The incidence of IPD was compared between the
early-HAART and established-HAART eras in HIV-infected and–uninfected
individuals.
Results. A
total of 2,567 IPD cases among individuals older than 18 years were
reported from 2003 through 2008. Overall incidence of IPD (per 100,000)
did not change during the study period in HIV-infected adults (207.4
cases in the early-HAART and 214.0 cases in the established-HAART era; p
= 0.55). IPD incidence, actually increased 1.16-fold (95% CI: 1.01;
1.62) in HIV-infected females between the early-and established-HAART
eras (212.1 cases and 246.2 cases, respectively; p = 0.03). The
incidence of IPD remained unchanged in HIV-uninfected adults across the
three time periods.
Conclusion. Despite a stable prevalence of HIV and the increased roll-out of HAART for treatment of AIDS patients
in our setting, the burden of IPD has not decreased among HIV-infected
adults. The study indicates a need for ongoing monitoring of disease and
HAART program effectiveness to reduce opportunistic infections in
African adults with HIV/AIDS, as well as the need to consider alternate strategies including pneumococcal conjugate vaccine immunization for the prevention of IPD in HIV-infected adults.
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