Incidence and Risk Factors for Invasive Pneumococcal Disease in HIV-Infected and Non-HIV-Infected Individuals Before and After the Introduction of Combination Antiretroviral Therapy: Persistent High Risk Among HIV-Infected Injecting Drug Users
Background. Invasive pneumococcal disease (IPD) is an important cause of morbidity among individuals infected with human immunodeficiency virus (HIV). We described incidence and risk factors for IPD in HIV-infected and uninfected individuals. Methods. Nationwide population-based cohort study of HIV-...
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| Veröffentlicht in: | Clinical infectious diseases 2014-10, Vol.59 (8), p.1168-1176 |
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| creator | Harboe, Zitta Barrella Larsen, Mette Vang Ladelund, Steen Kronborg, Gitte Konradsen, Helle Bossen Gerstoft, Jan Larsen, Carsten Schade Pedersen, Court Pedersen, Gitte Obel, Niels Benfield, Thomas |
| description | Background. Invasive pneumococcal disease (IPD) is an important cause of morbidity among individuals infected with human immunodeficiency virus (HIV). We described incidence and risk factors for IPD in HIV-infected and uninfected individuals. Methods. Nationwide population-based cohort study of HIV-infected adults treated at all Danish HIV treatment centers during 1995–2012. Nineteen population-matched controls per HIV-infected individual were retrieved. The risk of IPD was assessed using Poisson regression. Results. The incidence of IPD was 304.7 cases per 100 000 person-years of follow-up (PYFU) in HIV-infected and 12.8 per 100 000 PYFU in HIV-uninfected individuals. After adjusting for confounders, HIV infection (relative risk [RR], 24.4 [95% confidence interval [CI], 23.7–25.1]), male sex (RR, 1.20 [95% CI, 1.16–1.24]), increasing age (per year) (RR, 1.03 [95% CI, 1.03–1.04]), and calendar period (pre-cART RR, 2.80 [95% CI, 2.70–2.91] compared with late cART) were significantly associated with an increased risk of IPD. Among HIV-infected individuals, male sex (RR, 1.57 [95% CI, 1.49–1.66]), smoking (RR, 1.34 [95% CI, 1.26–1.42]), and injecting drug use (RR, 2.51 [95% CI, 2.26–2.67]) were associated with an increased risk of IPD. Detectable viral loads (RR, 1.88 [95% CI, 1.79–1.98]) and a relative fall in CD4 T-cell counts were also associated with an increased risk (≥500 to 350–500 CD4 T cells/μL: RR, 1.29 [95% CI, 1.21–1.37] and |
| doi_str_mv | 10.1093/cid/ciu558 |
| format | Article |
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Invasive pneumococcal disease (IPD) is an important cause of morbidity among individuals infected with human immunodeficiency virus (HIV). We described incidence and risk factors for IPD in HIV-infected and uninfected individuals. Methods. Nationwide population-based cohort study of HIV-infected adults treated at all Danish HIV treatment centers during 1995–2012. Nineteen population-matched controls per HIV-infected individual were retrieved. The risk of IPD was assessed using Poisson regression. Results. The incidence of IPD was 304.7 cases per 100 000 person-years of follow-up (PYFU) in HIV-infected and 12.8 per 100 000 PYFU in HIV-uninfected individuals. After adjusting for confounders, HIV infection (relative risk [RR], 24.4 [95% confidence interval [CI], 23.7–25.1]), male sex (RR, 1.20 [95% CI, 1.16–1.24]), increasing age (per year) (RR, 1.03 [95% CI, 1.03–1.04]), and calendar period (pre-cART RR, 2.80 [95% CI, 2.70–2.91] compared with late cART) were significantly associated with an increased risk of IPD. Among HIV-infected individuals, male sex (RR, 1.57 [95% CI, 1.49–1.66]), smoking (RR, 1.34 [95% CI, 1.26–1.42]), and injecting drug use (RR, 2.51 [95% CI, 2.26–2.67]) were associated with an increased risk of IPD. Detectable viral loads (RR, 1.88 [95% CI, 1.79–1.98]) and a relative fall in CD4 T-cell counts were also associated with an increased risk (≥500 to 350–500 CD4 T cells/μL: RR, 1.29 [95% CI, 1.21–1.37] and <100 cells/μL: RR, 7.4 [95% CI, 6.87–8.02]). The risk of IPD declined over time, although this was not the case for IDUs where the risk remained unchanged. Conclusions. The incidence of IPD in HIV-infected individuals remained significantly higher than the incidence observed in non-HIV-infected subjects, despite the widespread use of cART. IDUs have a persistently high risk of IPD. Injecting drug use, smoking, and the receipt of cART are suitable targets for preventive measures in the future.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1093/cid/ciu558</identifier><identifier>PMID: 25038114</identifier><language>eng</language><publisher>United States: OXFORD UNIVERSITY PRESS</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; AIDS ; Anti-Retroviral Agents - therapeutic use ; Antiretroviral drugs ; Antiretrovirals ; Bacteremia - epidemiology ; Carts ; Cells ; Cohort Studies ; Denmark - epidemiology ; Disease risk ; Drug therapy ; Drug use ; Epidemiology ; Female ; HIV ; HIV infections ; HIV Infections - complications ; HIV Infections - drug therapy ; HIV/AIDS ; Human immunodeficiency virus ; Humans ; Incidence ; Injections ; Male ; Meningitis, Bacterial - epidemiology ; Middle Aged ; Morbidity ; Pneumococcal Infections - epidemiology ; Pneumococcal vaccines ; Predisposing factors ; Risk Factors ; Streptococcus infections ; Substance Abuse, Intravenous - complications ; Viral diseases ; Young Adult</subject><ispartof>Clinical infectious diseases, 2014-10, Vol.59 (8), p.1168-1176</ispartof><rights>Copyright © 2014 Oxford University Press on behalf of the Infectious Diseases Society of America</rights><rights>The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.</rights><rights>Copyright Oxford University Press, UK Oct 15, 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c344t-a1d091e5790b3369a3d7976b5033e9207db3759a72ca1e6b2a8be11abd628e5e3</citedby><cites>FETCH-LOGICAL-c344t-a1d091e5790b3369a3d7976b5033e9207db3759a72ca1e6b2a8be11abd628e5e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/24032286$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/24032286$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>314,780,784,803,27924,27925,58017,58250</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25038114$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Harboe, Zitta Barrella</creatorcontrib><creatorcontrib>Larsen, Mette Vang</creatorcontrib><creatorcontrib>Ladelund, Steen</creatorcontrib><creatorcontrib>Kronborg, Gitte</creatorcontrib><creatorcontrib>Konradsen, Helle Bossen</creatorcontrib><creatorcontrib>Gerstoft, Jan</creatorcontrib><creatorcontrib>Larsen, Carsten Schade</creatorcontrib><creatorcontrib>Pedersen, Court</creatorcontrib><creatorcontrib>Pedersen, Gitte</creatorcontrib><creatorcontrib>Obel, Niels</creatorcontrib><creatorcontrib>Benfield, Thomas</creatorcontrib><title>Incidence and Risk Factors for Invasive Pneumococcal Disease in HIV-Infected and Non-HIV-Infected Individuals Before and After the Introduction of Combination Antiretroviral Therapy: Persistent High Risk Among HIV-Infected Injecting Drug Users</title><title>Clinical infectious diseases</title><addtitle>Clin Infect Dis</addtitle><description>Background. Invasive pneumococcal disease (IPD) is an important cause of morbidity among individuals infected with human immunodeficiency virus (HIV). We described incidence and risk factors for IPD in HIV-infected and uninfected individuals. Methods. Nationwide population-based cohort study of HIV-infected adults treated at all Danish HIV treatment centers during 1995–2012. Nineteen population-matched controls per HIV-infected individual were retrieved. The risk of IPD was assessed using Poisson regression. Results. The incidence of IPD was 304.7 cases per 100 000 person-years of follow-up (PYFU) in HIV-infected and 12.8 per 100 000 PYFU in HIV-uninfected individuals. After adjusting for confounders, HIV infection (relative risk [RR], 24.4 [95% confidence interval [CI], 23.7–25.1]), male sex (RR, 1.20 [95% CI, 1.16–1.24]), increasing age (per year) (RR, 1.03 [95% CI, 1.03–1.04]), and calendar period (pre-cART RR, 2.80 [95% CI, 2.70–2.91] compared with late cART) were significantly associated with an increased risk of IPD. Among HIV-infected individuals, male sex (RR, 1.57 [95% CI, 1.49–1.66]), smoking (RR, 1.34 [95% CI, 1.26–1.42]), and injecting drug use (RR, 2.51 [95% CI, 2.26–2.67]) were associated with an increased risk of IPD. Detectable viral loads (RR, 1.88 [95% CI, 1.79–1.98]) and a relative fall in CD4 T-cell counts were also associated with an increased risk (≥500 to 350–500 CD4 T cells/μL: RR, 1.29 [95% CI, 1.21–1.37] and <100 cells/μL: RR, 7.4 [95% CI, 6.87–8.02]). The risk of IPD declined over time, although this was not the case for IDUs where the risk remained unchanged. Conclusions. The incidence of IPD in HIV-infected individuals remained significantly higher than the incidence observed in non-HIV-infected subjects, despite the widespread use of cART. IDUs have a persistently high risk of IPD. Injecting drug use, smoking, and the receipt of cART are suitable targets for preventive measures in the future.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>AIDS</subject><subject>Anti-Retroviral Agents - therapeutic use</subject><subject>Antiretroviral drugs</subject><subject>Antiretrovirals</subject><subject>Bacteremia - epidemiology</subject><subject>Carts</subject><subject>Cells</subject><subject>Cohort Studies</subject><subject>Denmark - epidemiology</subject><subject>Disease risk</subject><subject>Drug therapy</subject><subject>Drug use</subject><subject>Epidemiology</subject><subject>Female</subject><subject>HIV</subject><subject>HIV infections</subject><subject>HIV Infections - complications</subject><subject>HIV Infections - drug therapy</subject><subject>HIV/AIDS</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Incidence</subject><subject>Injections</subject><subject>Male</subject><subject>Meningitis, Bacterial - epidemiology</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Pneumococcal Infections - epidemiology</subject><subject>Pneumococcal vaccines</subject><subject>Predisposing factors</subject><subject>Risk Factors</subject><subject>Streptococcus infections</subject><subject>Substance Abuse, Intravenous - complications</subject><subject>Viral diseases</subject><subject>Young Adult</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkk1v1DAQhiMEoqVw4Q6yxAUhBTxx7CTcli1lI1VQoZZr5NiTXS8be7Gdlfq7-wdqmgKiB8vjmWc-5Hey7CXQ90Ab9kEZnc7Eef0oOwbOqlzwBh4nm_I6L2tWH2XPQthSClBT_jQ7KjhlNUB5nN20NqWjVUik1eS7CT_JmVTR-UAG50lrDzKYA5ILi9PolFNK7sipCSgDEmPJqv2Rt3ZAFVHflfjqbP6fs7XaHIye5C6QT5iKzq0WQ0RP4gYTEL3Tk4rGWeIGsnRjb6y8ey5sNB5T_GB8any5QS_31x_JBfpgQkQbycqsN_Pgi9HZNXnQfJsMk9ynflqTq5DynmdPhjQMvri_T7Krs8-Xy1V-_u1Lu1yc54qVZcwlaNoA8qqhPWOikUxXTSX69HcMm4JWumcVb2RVKAko-kLWPQLIXouiRo7sJHs7191792vCELvRBIW7nbToptABFwKSgoIm9M0DdOsmb9N0HQigUBZQs0S9mynlXQgeh27vzSj9dQe0-70KXdKym1chwa_vS079iPov-kf7BLyagW1Icv-Ll5QVRS3YLbnHvG4</recordid><startdate>20141015</startdate><enddate>20141015</enddate><creator>Harboe, Zitta Barrella</creator><creator>Larsen, Mette Vang</creator><creator>Ladelund, Steen</creator><creator>Kronborg, Gitte</creator><creator>Konradsen, Helle Bossen</creator><creator>Gerstoft, Jan</creator><creator>Larsen, Carsten Schade</creator><creator>Pedersen, Court</creator><creator>Pedersen, Gitte</creator><creator>Obel, Niels</creator><creator>Benfield, Thomas</creator><general>OXFORD UNIVERSITY PRESS</general><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7T2</scope><scope>7T7</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>20141015</creationdate><title>Incidence and Risk Factors for Invasive Pneumococcal Disease in HIV-Infected and Non-HIV-Infected Individuals Before and After the Introduction of Combination Antiretroviral Therapy: Persistent High Risk Among HIV-Infected Injecting Drug Users</title><author>Harboe, Zitta Barrella ; Larsen, Mette Vang ; Ladelund, Steen ; Kronborg, Gitte ; Konradsen, Helle Bossen ; Gerstoft, Jan ; Larsen, Carsten Schade ; Pedersen, Court ; Pedersen, Gitte ; Obel, Niels ; Benfield, Thomas</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c344t-a1d091e5790b3369a3d7976b5033e9207db3759a72ca1e6b2a8be11abd628e5e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>AIDS</topic><topic>Anti-Retroviral Agents - therapeutic use</topic><topic>Antiretroviral drugs</topic><topic>Antiretrovirals</topic><topic>Bacteremia - epidemiology</topic><topic>Carts</topic><topic>Cells</topic><topic>Cohort Studies</topic><topic>Denmark - epidemiology</topic><topic>Disease risk</topic><topic>Drug therapy</topic><topic>Drug use</topic><topic>Epidemiology</topic><topic>Female</topic><topic>HIV</topic><topic>HIV infections</topic><topic>HIV Infections - complications</topic><topic>HIV Infections - drug therapy</topic><topic>HIV/AIDS</topic><topic>Human immunodeficiency virus</topic><topic>Humans</topic><topic>Incidence</topic><topic>Injections</topic><topic>Male</topic><topic>Meningitis, Bacterial - epidemiology</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>Pneumococcal Infections - epidemiology</topic><topic>Pneumococcal vaccines</topic><topic>Predisposing factors</topic><topic>Risk Factors</topic><topic>Streptococcus infections</topic><topic>Substance Abuse, Intravenous - complications</topic><topic>Viral diseases</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Harboe, Zitta Barrella</creatorcontrib><creatorcontrib>Larsen, Mette Vang</creatorcontrib><creatorcontrib>Ladelund, Steen</creatorcontrib><creatorcontrib>Kronborg, Gitte</creatorcontrib><creatorcontrib>Konradsen, Helle Bossen</creatorcontrib><creatorcontrib>Gerstoft, Jan</creatorcontrib><creatorcontrib>Larsen, Carsten Schade</creatorcontrib><creatorcontrib>Pedersen, Court</creatorcontrib><creatorcontrib>Pedersen, Gitte</creatorcontrib><creatorcontrib>Obel, Niels</creatorcontrib><creatorcontrib>Benfield, Thomas</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Harboe, Zitta Barrella</au><au>Larsen, Mette Vang</au><au>Ladelund, Steen</au><au>Kronborg, Gitte</au><au>Konradsen, Helle Bossen</au><au>Gerstoft, Jan</au><au>Larsen, Carsten Schade</au><au>Pedersen, Court</au><au>Pedersen, Gitte</au><au>Obel, Niels</au><au>Benfield, Thomas</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Incidence and Risk Factors for Invasive Pneumococcal Disease in HIV-Infected and Non-HIV-Infected Individuals Before and After the Introduction of Combination Antiretroviral Therapy: Persistent High Risk Among HIV-Infected Injecting Drug Users</atitle><jtitle>Clinical infectious diseases</jtitle><addtitle>Clin Infect Dis</addtitle><date>2014-10-15</date><risdate>2014</risdate><volume>59</volume><issue>8</issue><spage>1168</spage><epage>1176</epage><pages>1168-1176</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><abstract>Background. Invasive pneumococcal disease (IPD) is an important cause of morbidity among individuals infected with human immunodeficiency virus (HIV). We described incidence and risk factors for IPD in HIV-infected and uninfected individuals. Methods. Nationwide population-based cohort study of HIV-infected adults treated at all Danish HIV treatment centers during 1995–2012. Nineteen population-matched controls per HIV-infected individual were retrieved. The risk of IPD was assessed using Poisson regression. Results. The incidence of IPD was 304.7 cases per 100 000 person-years of follow-up (PYFU) in HIV-infected and 12.8 per 100 000 PYFU in HIV-uninfected individuals. After adjusting for confounders, HIV infection (relative risk [RR], 24.4 [95% confidence interval [CI], 23.7–25.1]), male sex (RR, 1.20 [95% CI, 1.16–1.24]), increasing age (per year) (RR, 1.03 [95% CI, 1.03–1.04]), and calendar period (pre-cART RR, 2.80 [95% CI, 2.70–2.91] compared with late cART) were significantly associated with an increased risk of IPD. Among HIV-infected individuals, male sex (RR, 1.57 [95% CI, 1.49–1.66]), smoking (RR, 1.34 [95% CI, 1.26–1.42]), and injecting drug use (RR, 2.51 [95% CI, 2.26–2.67]) were associated with an increased risk of IPD. Detectable viral loads (RR, 1.88 [95% CI, 1.79–1.98]) and a relative fall in CD4 T-cell counts were also associated with an increased risk (≥500 to 350–500 CD4 T cells/μL: RR, 1.29 [95% CI, 1.21–1.37] and <100 cells/μL: RR, 7.4 [95% CI, 6.87–8.02]). The risk of IPD declined over time, although this was not the case for IDUs where the risk remained unchanged. Conclusions. The incidence of IPD in HIV-infected individuals remained significantly higher than the incidence observed in non-HIV-infected subjects, despite the widespread use of cART. IDUs have a persistently high risk of IPD. Injecting drug use, smoking, and the receipt of cART are suitable targets for preventive measures in the future.</abstract><cop>United States</cop><pub>OXFORD UNIVERSITY PRESS</pub><pmid>25038114</pmid><doi>10.1093/cid/ciu558</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Clinical infectious diseases, 2014-10, Vol.59 (8), p.1168-1176 |
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| source | MEDLINE; JSTOR Archive Collection A-Z Listing; Oxford University Press Journals All Titles (1996-Current); EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adolescent Adult Aged Aged, 80 and over AIDS Anti-Retroviral Agents - therapeutic use Antiretroviral drugs Antiretrovirals Bacteremia - epidemiology Carts Cells Cohort Studies Denmark - epidemiology Disease risk Drug therapy Drug use Epidemiology Female HIV HIV infections HIV Infections - complications HIV Infections - drug therapy HIV/AIDS Human immunodeficiency virus Humans Incidence Injections Male Meningitis, Bacterial - epidemiology Middle Aged Morbidity Pneumococcal Infections - epidemiology Pneumococcal vaccines Predisposing factors Risk Factors Streptococcus infections Substance Abuse, Intravenous - complications Viral diseases Young Adult |
| title | Incidence and Risk Factors for Invasive Pneumococcal Disease in HIV-Infected and Non-HIV-Infected Individuals Before and After the Introduction of Combination Antiretroviral Therapy: Persistent High Risk Among HIV-Infected Injecting Drug Users |
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