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

Zitta Barrella Harboe; Mette Vang Larsen; Steen Ladelund; Gitte Kronborg; Helle Bossen Konradsen; Jan Gerstoft; Carsten Schade Larsen; Court Pedersen; Gitte Pedersen; Niels Obel; Thomas Benfield

doi:10.1093/cid/ciu558

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

Zitta Barrella Harboe, Mette Vang Larsen, Steen Ladelund, Gitte Kronborg, Helle Bossen Konradsen, Jan Gerstoft, Carsten Schade Larsen, Court Pedersen, Gitte Pedersen, Niels Obel, Thomas Benfield

Department of Clinical Medicine

32 Citations (Scopus)

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.

Original language	English
Journal	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Volume	59
Issue number	8
Pages (from-to)	1168-1176
Number of pages	9
ISSN	1058-4838
DOIs	https://doi.org/10.1093/cid/ciu558
Publication status	Published - 15 Oct 2014

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Harboe, Z. B., Larsen, M. V., Ladelund, S., Kronborg, G., Konradsen, H. B., Gerstoft, J., Larsen, C. S., Pedersen, C., Pedersen, G., Obel, N., & Benfield, T. (2014). 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. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 59(8), 1168-1176. https://doi.org/10.1093/cid/ciu558

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. / Harboe, Zitta Barrella; Larsen, Mette Vang; Ladelund, Steen et al.
In: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Vol. 59, No. 8, 15.10.2014, p. 1168-1176.

Research output: Contribution to journal › Journal article › Research › peer-review

Harboe, ZB, Larsen, MV, Ladelund, S, Kronborg, G, Konradsen, HB, Gerstoft, J, Larsen, CS, Pedersen, C, Pedersen, G, Obel, N & Benfield, T 2014, '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', Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, vol. 59, no. 8, pp. 1168-1176. https://doi.org/10.1093/cid/ciu558

Harboe ZB, Larsen MV, Ladelund S, Kronborg G, Konradsen HB, Gerstoft J et al. 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. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2014 Oct 15;59(8):1168-1176. doi: 10.1093/cid/ciu558

Harboe, Zitta Barrella ; Larsen, Mette Vang ; Ladelund, Steen et al. / 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. In: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2014 ; Vol. 59, No. 8. pp. 1168-1176.

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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",

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.",

author = "Harboe, {Zitta Barrella} and Larsen, {Mette Vang} and Steen Ladelund and Gitte Kronborg and Konradsen, {Helle Bossen} and Jan Gerstoft and Larsen, {Carsten Schade} and Court Pedersen and Gitte Pedersen and Niels Obel and Thomas Benfield",

note = "{\textcopyright} 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: [email protected].",

year = "2014",

month = oct,

day = "15",

doi = "10.1093/cid/ciu558",

language = "English",

volume = "59",

pages = "1168--1176",

journal = "Clinical infectious diseases : an official publication of the Infectious Diseases Society of America",

issn = "1058-4838",

publisher = "Oxford University Press",

number = "8",

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TY - JOUR

T1 - 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

T2 - Persistent High Risk Among HIV-Infected Injecting Drug Users

AU - Harboe, Zitta Barrella

AU - Larsen, Mette Vang

AU - Ladelund, Steen

AU - Kronborg, Gitte

AU - Konradsen, Helle Bossen

AU - Gerstoft, Jan

AU - Larsen, Carsten Schade

AU - Pedersen, Court

AU - Pedersen, Gitte

AU - Obel, Niels

AU - Benfield, Thomas

PY - 2014/10/15

Y1 - 2014/10/15

N2 - 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.

AB - 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.

U2 - 10.1093/cid/ciu558

DO - 10.1093/cid/ciu558

M3 - Journal article

C2 - 25038114

SN - 1058-4838

VL - 59

SP - 1168

EP - 1176

JO - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

IS - 8

ER -