[MoOrB1009] Streptococcus pneumoniae (Sp) in HIV-infected adults: risk for infection and antimicrobial susceptibilities

14th International AIDS Conference

Barcelona, Spain — July 7-12, 2002

[TITLE:] Streptococcus pneumoniae (Sp) in HIV-infected adults: risk for infection and antimicrobial susceptibilities

[AUTHOR(S):] J.T. Brooks, M.R. Adams, A.D. McNaghten, D.L. Swerdlow¹

Int Conf AIDS. 2002 Jul 7-12;14:Abstract No. MoOrB1009

BACKGROUND: We sought to characterize factors associated with increased risk of Sp infection and isolation of nonsusceptible strains in HIV-infected adults.

METHODS: We used data from the ASD Project, which longitudinally abstracts medical records of HIV-infected persons >13 years old at >100 clinics in 11 U.S. cities. We compared Sp infection-associated relative risks (RR) according to demographics, CD4 count, history of pneumococcal vaccination and trimethoprim-sulfamethoxazole (TMP-SMZ) prophylaxis, and examined associations between antibiotic susceptibility and invasive (CSF, blood) vs. noninvasive (sputum) infections by the chi-square method using 95% confidence intervals (CI).

RESULTS: We identified 82 Sp infections among 79 of 15,080 persons observed a median 4.50 years since 1993. Sp infections rose from 3.30 to 5.43 per 1,000 person-years per decile between ages 20-29 to 50-59. Risk for blacks (RR 3.3, p<0.01) was greater than for whites (RR 2.44, p=0.04) or Hispanics' (referent). Risk for injection drug users (IDUs) was greater (RR 1.9, p=0.02) than for men who have sex with men (referent). Risk of invasive Sp infection was not altered by CD4 count, a CD4 nadir <200, vaccination, or TMP-SMZ prophylaxis before first Sp infection. Overall 26/71 (31%) isolates tested were nonsusceptible to penicillin, 10/43 (23%) to 3rd generation cephalosporins (CPH3), 10/28 (26%) to erythromycin, 17/24 (71%) to TMP-SMZ, and 3/19 (16%) to quinolones. Invasive isolates tended to be more susceptible. More Sp nonsusceptible to CPH3 were isolated from persons with CD4 nadirs <200 (7/8 [88%]) vs. CD4 nadir ≥200 cells/mL (11/26 [42%], RR 6.2, CI 0.9-460, p=0.04).

CONCLUSIONS: Incidence of Sp infection increased with age. Blacks and IDUs were at greatest risk. Risk of invasive infection was not altered by CD4 nadir <200, pneumococcal vaccination, or TMP-SMZ prophylaxis. CPH3-nonsusceptible infections were associated with CD4 nadirs<200.

Presenting author: John T. Brooks

1Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, NE - Mailstop E-47, Atlanta, GA 30333, United States.

020708
MoOrB1009