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Invasive pneumococcal disease among human immunodeficiency virus-infected children, 1989-2006

Andrew P Steenhoff1, Sarah M Wood, Richard M Rutstein

  • 1Division of Special Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. steenhoff@email.chop.edu

The Pediatric Infectious Disease Journal
|September 9, 2008
PubMed

Insights

Invasive pneumococcal disease (IPD) incidence decreased in HIV-infected children after highly active antiretroviral therapy (HAART) introduction. Further monitoring is needed to assess the impact of the heptavalent pneumococcal conjugate vaccine (PCV7) on IPD in this population.

Area of Science:

  • Pediatric Infectious Diseases
  • Immunology
  • Public Health

Background:

  • The heptavalent pneumococcal conjugate vaccine (PCV7) has reduced invasive pneumococcal disease (IPD) in the general pediatric population.
  • Limited data exist on IPD trends in children with human immunodeficiency virus (HIV).

Purpose of the Study:

  • To investigate the incidence and characteristics of IPD in perinatally HIV-infected children.
  • To evaluate the impact of highly active antiretroviral therapy (HAART) and PCV7 on IPD rates in this cohort.

Main Methods:

  • A retrospective study analyzing diagnostic codes and laboratory records for IPD cases in children (<18 years) at an urban HIV clinic from 1989 to 2006.
  • IPD incidence rates were calculated, and serotype distribution and antibiotic resistance patterns were analyzed.

Main Results:

  • A total of 256 children were followed for 1756 person-years, with 21 IPD episodes observed.
  • IPD incidence significantly decreased by 84% after HAART introduction (1862/100,000 PY to 292/100,000 PY).
  • Following PCV7 introduction, a non-significant increase in IPD incidence was noted (292/100,000 PY to 860/100,000 PY).

Conclusions:

  • HAART significantly reduced IPD incidence in perinatally HIV-infected children.
  • The effect of PCV7 on IPD in this vulnerable population requires ongoing surveillance.
  • Antibiotic resistance to penicillin and trimethoprim-sulfamethoxazole remains a concern.
Abstract

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