Invasive Pneumococcal Disease in People with HIV in England, 1999-2017

Abstract

Background: The 7-valent and 13-valent pneumococcal conjugate vaccines (PCVs) were introduced into the United Kingdom childhood immunisation programme in 2006 and 2010 respectively, with high effectiveness and resulting in both direct and indirect protection. We describe the epidemiology of invasive pneumococcal disease (IPD) in adults with HIV in England following the introduction of both PCVs. Methods: Data on a national cohort of people with HIV were linked to confirmed IPD cases in adults aged ≥15 years during 1999-2017. Date of HIV infection was estimated using a CD4 slope decline algorithm. Findings: Among 133,994 adults with HIV, 1,453 developed IPD during 1999-2017, with 70% (1,016/1,453) developing IPD ≥3 months after their HIV diagnosis. IPD and HIV were co-diagnosed within 90 days in 345 (24%) individuals. A missed opportunity for earlier HIV diagnosis was identified in 6% (89/1,453), mostly in earlier years. IPD incidence in people with HIV increased from 147/100,000 in 1999 to 284/100,000 in 2007 before declining and stabilising between 92-113/100,000 during 2014-2017. Mean annual IPD incidence was lower among those receiving ART during 2014-17 (720 vs. 68/100,000; IRR 9.3; 95%CI, 7.3-11.8; P<0.001) and was markedly lower in those with a suppressed viral load (523 vs. 50/100,000; IRR 10.4; 95%CI, 7.6-14.1; P<0.001). The latter group still had 4.5-fold higher (95%CI, 3.8-5.3; P<0.001) IPD incidence compared to the general population (11.2/100,000). Interpretation: IPD incidence among people with HIV reduced after PCV13 introduction and has remained stable. Adults presenting with IPD should continue to be tested for HIV infection. Funding Statement: The authors are employed by PHE. There was no additional funding for this study. Declaration of Interests: PDK, ZAC, SEC, CS, NF and VCD declare no conflicts of interest. SNL performs contract research on behalf of St. George’s University of London (SGUL) and Public Health England (PHE) for vaccine manufacturers but receives no personal remuneration. The Immunisation Department has provided vaccine manufacturers with post-marketing surveillance reports on pneumococcal and meningococcal infection which the companies are required to submit to the UK Licensing authority in compliance with their Risk Management Strategy. A cost recovery charge is made for these reports. Ethics Approval Statement: PHE has legal permission, provided by Regulation 3 of The Health Service (Control of Patient Information) Regulations 2002, to process patient confidential information for national surveillance of communicable diseases (http://www.legislation.gov.uk/uksi/2002/1438/regulation/3/made). This includes PHE’s responsibility to monitor the safety and effectiveness of vaccines.