Risk of invasive meningococcal disease in children and adults with HIV in England: a population-based cohort study.

Ruth D Simmons,Samuel Lattimore,Kazim Beebeejaun,Peter Kirwan,Ray Borrow,Valerie Delpech,Andrew Riordan,Mary E Ramsay,Shamez Ladhani

doi:10.1186/s12916-015-0538-6

Abstract

BackgroundRecent studies have identified HIV infection as a potential risk factor for invasive meningococcal disease (IMD), suggesting that HIV-infected individuals could benefit from meningococcal vaccination to reduce their risk of this rare, but severe and potentially fatal infection. In the United Kingdom, as in most industrialised countries, HIV is not considered a risk factor for IMD.MethodsIMD incidence and relative risk by age group and meningococcal capsular group in HIV-positive compared with HIV-uninfected individuals was estimated through data linkage of national datasets in England between 2011 and 2013.ResultsIMD incidence among persons diagnosed with HIV was 6.6 per 100,000 compared to 1.5 per 100,000 among HIV-negative individuals, with a relative risk of 4.5 (95 % CI, 2.7–7.5). All but one case occurred in adults aged 16–64 years, who had a 22.7-fold (95 % CI, 12.4–41.6; P <0.001) increased risk compared with the HIV-negative adults. IMD risk by capsular group varied with age. HIV-positive children and adolescents had a higher risk of meningococcal group B disease, while adults were at increased risk of groups C, W and Y disease. Most HIV-positive individuals had been born in Africa, had acquired HIV through heterosexual contact, and were known to be HIV-positive and receiving antiretroviral treatment at IMD diagnosis. The most common clinical presentation was septicemia and, although intensive care admission was common, none died of IMD.ConclusionsHIV-positive children and adults are at significantly increased risk of IMD, providing an evidence base for policy makers to consider HIV as a risk factor for meningococcal vaccination.

Highlights

Recent studies have identified human immunodeficiency virus (HIV) infection as a potential risk factor for invasive meningococcal disease (IMD), suggesting that HIV-infected individuals could benefit from meningococcal vaccination to reduce their risk of this rare, but severe and potentially fatal infection
HIV surveillance In addition to the information collected through general practitioner (GP) questionnaires, all confirmed cases of IMD were matched to all persons newly diagnosed with HIV between 1981 and 2013, collected through a comprehensive national cohort of persons presenting for an HIV test across all testing facilities in England and subsequently accessing HIV care
During a period when antiretroviral therapy (ART) was routinely available in England, persons diagnosed with HIV had a 4.8-fold increased risk of IMD compared with individuals not known to be HIV infected

Summary

Introduction

Recent studies have identified HIV infection as a potential risk factor for invasive meningococcal disease (IMD), suggesting that HIV-infected individuals could benefit from meningococcal vaccination to reduce their risk of this rare, but severe and potentially fatal infection. In the United Kingdom, as in most industrialised countries, HIV is not considered a risk factor for IMD. Twelve distinct polysaccharide capsules have been described, including five that are responsible for almost all cases of invasive meningococcal disease (IMD) globally: A, B, C, W and Y [1]. In the United Kingdom, as in most of Europe, meningococcal groups B (MenB) and C (MenC) were previously responsible for most IMD cases [2]. Invasive MenC disease, is uncommon since routine vaccination against MenC was introduced in 1999, with most cases occurring in unvaccinated adults who acquire the infection abroad [2]. Meningococcal groups W (MenW) and Y (MenY) are uncommon and mainly cause disease in older adults, the UK is currently experiencing a national outbreak of MenW disease across

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