Abstract

BackgroundHighly active antiretroviral treatment (HAART) programs have been associated with declines in the burden of invasive pneumococcal disease (IPD) in industrialized countries. The aim of this study was to evaluate trends in IPD hospitalizations in HIV-infected adults in Soweto, South Africa, associated with up-scaling of the HAART program from 2003 to 2008.MethodsLaboratory-confirmed IPD cases were identified from 2003 through 2008 through an existing surveillance program. The period 2003-04 was designated as the early-HAART era, 2005–06 as the intermediate-HAART era and 2007–08 as the established-HAART era. The incidence of IPD was compared between the early-HAART and established-HAART eras in HIV-infected and–uninfected individuals.ResultsA total of 2,567 IPD cases among individuals older than 18 years were reported from 2003 through 2008. Overall incidence of IPD (per 100,000) did not change during the study period in HIV-infected adults (207.4 cases in the early-HAART and 214.0 cases in the established-HAART era; p = 0.55). IPD incidence, actually increased 1.16-fold (95% CI: 1.01; 1.62) in HIV-infected females between the early-and established-HAART eras (212.1 cases and 246.2 cases, respectively; p = 0.03). The incidence of IPD remained unchanged in HIV-uninfected adults across the three time periods.ConclusionDespite a stable prevalence of HIV and the increased roll-out of HAART for treatment of AIDS patients in our setting, the burden of IPD has not decreased among HIV-infected adults. The study indicates a need for ongoing monitoring of disease and HAART program effectiveness to reduce opportunistic infections in African adults with HIV/AIDS, as well as the need to consider alternate strategies including pneumococcal conjugate vaccine immunization for the prevention of IPD in HIV-infected adults.

Highlights

  • HIV-infected adults in the absence of highly active antiretroviral treatment (HAART) have an increased risk of developing invasive disease from Streptococcus pneumoniae (IPD) and are at heightened susceptibility of recurrent invasive pneumococcal disease (IPD) episodes. [1,2,3,4] The initiation of Highly active antiretroviral treatment (HAART) in many developed countries since the mid-1990s has been associated with marked reductions in morbidity and mortality from opportunistic infections due to humoral and cellmediated immune reconstitution with HAART. [5] Protection against IPD is dependent upon opsonisation of the pneumococcus by antibodies and subsequent killing thereof by phagocytic activity

  • HIV-infected adults in the absence of highly active antiretroviral treatment (HAART) have an increased risk of developing invasive disease from Streptococcus pneumoniae (IPD) and are at heightened susceptibility of recurrent IPD episodes. [1,2,3,4] The initiation of HAART in many developed countries since the mid-1990s has been associated with marked reductions in morbidity and mortality from opportunistic infections due to humoral and cellmediated immune reconstitution with HAART

  • [11] The estimated prevalence of HIV among African adults aged 18–64 years was 25% in 2004 and 27% in 2008 in the province of Gauteng, South Africa, where this study was undertaken. [12,13,14] Previous studies on the impact of HIV/AIDS on IPD in adults in South Africa were undertaken prior to the HAART era. [2,15,16] Determination of the impact of HAART on the burden of IPD in African settings is necessary to determine whether the prevention of IPD in African HIV-infected individuals remains a priority

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Summary

Introduction

HIV-infected adults in the absence of highly active antiretroviral treatment (HAART) have an increased risk of developing invasive disease from Streptococcus pneumoniae (IPD) and are at heightened susceptibility of recurrent IPD episodes. [1,2,3,4] The initiation of HAART in many developed countries since the mid-1990s has been associated with marked reductions in morbidity and mortality from opportunistic infections due to humoral and cellmediated immune reconstitution with HAART. [5] Protection against IPD is dependent upon opsonisation of the pneumococcus by antibodies and subsequent killing thereof by phagocytic activity. Two- to three-fold reductions in the risk of IPD have been observed among HIV-infected adults developed country settings where HAART programs have been effectively implemented. A few studies have been published to date from Africa, the continent with the highest prevalence and number of individuals with HIV/AIDS, suggesting a reduction in opportunistic infections incidence with HAART usage. The aim of this study was to evaluate the impact of the HAART program on the burden of hospitalization for IPD in South African HIV-infected adults. Active antiretroviral treatment (HAART) programs have been associated with declines in the burden of invasive pneumococcal disease (IPD) in industrialized countries. The aim of this study was to evaluate trends in IPD hospitalizations in HIV-infected adults in Soweto, South Africa, associated with up-scaling of the HAART program from 2003 to 2008

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