Comparative Study
The impact of HIV on Streptococcus pneumoniae bacteraemia in a South African population
N Jones et al. AIDS. .
Abstract
Objectives: To determine the impact of HIV infection on Streptococcus pneumoniae bacteraemia in adults and children by analysing the prevalence and clinical features of such diseases and determining the prevalent serotypes/serogroups and susceptibility patterns of isolates.
Design: Patients were identified prospectively from January to October 1996.
Setting: Chris Hani Baragwanath Hospital, Soweto, a tertiary referral hospital treating adults and children, in an urban district near Johannesburg, South Africa.
Patients and methods: All patients with S. pneumoniae isolated from blood culture by the Microbiology Department, Chris Hani Baragwanath Hospital were studied. Clinical and microbiological features were recorded.
Results: A total of 178 patients with S. pneumoniae were investigated as part of the study; 49 were aged < 13 years. HIV seroinfection was present in 25 (51%) children and 58 (45%) adults. The incidence of S. pneumoniae bacteraemia was 36.9-fold increased in HIV-seropositive children and 8.2-fold increased in HIV-seropositive adults compared with HIV-seronegative individuals. Both adult and paediatric HIV-seropositive patients with S. pneumoniae bacteraemia were significantly younger than HIV-seronegative patients. Pneumonia was a significantly more common presentation in HIV-seropositive children, otherwise the spectrum of disease and outcome were similar in HIV-seronegative and positive groups. Serotype 1 S. pneumoniae isolates were significantly less common in HIV-infected individuals (both adults and children). Resistance to penicillin was increased in S. pneumoniae isolates from HIV-infected patients (significant in adults). Patients with penicillin-resistant isolates did not have a poorer outcome. The potential coverage of serotypes/serogroups included in the proposed nine-valent conjugate pneumococcal vaccine was 88% in HIV-seronegative children and 83% in HIV-seropositive children. The potential coverage of the currently available 23-valent pneumococcal vaccine for adults was 98.2 and 100)% for HIV-infected and HIV-uninfected adults, respectively.
Conclusion: The burden of bacteraemia due to S. pneumoniae in HIV-seropositive individuals admitted to our hospital is considerable. Differences in the S. pneumoniae serotypes/serogroups in HIV-infected patients have been demonstrated with resultant differences in antibiotic susceptibility patterns. Excellent potential for vaccine coverage was demonstrated for both HIV-seronegative and HIV-seropositive individuals. Further studies are necessary to test the clinical efficacy of pneumococcal vaccination of HIV-seropositive adults and children as a potential preventative measure against this prevalent disease.
PIP: Findings are presented from a study conducted to determine the impact of HIV infection upon Streptococcus pneumoniae bacteremia in adults and children by analyzing the prevalence and clinical features of such diseases and determining the prevalent serotypes/serogroups and susceptibility patterns of isolates. 178 patients with S. pneumoniae identified prospectively through blood culture during January-October 1996 at Chris Hani Baragwanath Hospital, Soweto, were studied. 49 patients were under 13 years old. 25 (51%) children and 58 (45%) adults were found to be infected with HIV. The incidence of S. pneumoniae bacteremia was 36.9 times higher in HIV-seropositive children and 8.2 times higher in HIV-seropositive adults compared to HIV-seronegative individuals. The HIV-seropositive patients with S. pneumoniae bacteremia were significantly younger than HIV-seronegative patients. Pneumonia was a significantly more common presentation in HIV-seropositive children; otherwise, the spectrum of disease and outcome were similar in HIV-seronegative and seropositive groups. There is extremely good potential for vaccine coverage for both HIV-negative and HIV-positive individuals.
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