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1 April 2008

Volume 46, Number 7
Clinical Infectious Diseases 2008;46:1093–1100
© 2008 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2008/4607-0021$15.00
DOI: 10.1086/529201
HIV/AIDS MAJOR ARTICLE

Impact of Pneumococcal Vaccination on the Incidence of Pneumonia by HIV Infection Status among Patients Enrolled in the Veterans Aging Cohort 5-Site Study

Maria C. Rodriguez-Barradas,1

Joseph Goulet,2,3

Sheldon Brown,4

Matthew Bidwell Goetz,6

David Rimland,7,8

Michael S. Simberkoff,5

Kristina Crothers,2,3 and

Amy C. Justice2,3

1Medical Service, Michael E. De Bakey Veterans Affairs (VA) Medical Center and Department of Medicine, Baylor College of Medicine, Houston, Texas; 2Veterans Aging Cohort Study Center, VA Connecticut Healthcare System, and 3Department of Medicine, Yale University School of Medicine, New Haven, Connecticut; 4Bronx VA Medical Center and Mt. Sinai School of Medicine and 5VA New York Harbor Healthcare System and New York University School of Medicine, New York; 6Department of Medicine VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at University of California Los Angeles, Los Angeles; and 7VA Medical Center and 8Emory University School of Medicine, Atlanta, Georgia

Background.  Human immunodeficiency virus (HIV)–infected persons have a high incidence of pneumonia and pneumococcal disease. Benefits of vaccination with the 23-valent pneumococcal polysaccharide vaccine (PPV) among these patients continue to be debated.

Methods.  The impact of PPV vaccination on the incidence of pneumonia events (i.e., the composite of pneumococcal pneumonia and pneumonia due to nonspecified organisms) was examined among participants in the Veterans Aging Cohort 5-Site Study, an ongoing prospective study of HIV-infected patients matched to an HIV-uninfected control group. Dates of PPV vaccination and pneumonia were determined by retrospective review of electronic medical records. Time to events was measured for up to 2 years from PPV vaccination or from enrollment for vaccinated and unvaccinated patients, respectively. Kaplan-Meier and Cox proportional hazards regression methods were used to examine the incidence of pneumonia by HIV infection and PPV vaccination status.

Results.  Among 692 HIV-uninfected and 934 HIV-infected study participants, 59% were vaccinated with PPV. The 2-year incidence of pneumonia was 6% (97 participants developed pneumonia). HIV-infected patients had a higher rate of pneumonia (hazard ratio, 5.81; 95% confidence interval, 3.15–10.71); overall, vaccinated patients showed a trend toward lower risk of pneumonia (hazard ratio, 0.75; 95% confidence interval, 0.50–1.13). Among HIV-infected patients, after controlling for HIV-specific and other variables, vaccination significantly reduced the risk of pneumonia (hazard ratio, 0.65; 95% confidence interval, 0.42–1.00); current smoking, low hemoglobin level, and low CD4 cell count significantly increased such risk. The effect of PPV vaccination among HIV-uninfected patients was not significant.

Conclusions.  Among HIV-infected patients, PPV vaccination offered protection against pneumonia. Smoking cessation needs to be pursued as an additional strategy for preventing pneumonia.

Received 20 July 2007; accepted 26 November 2007; electronically published 29 February 2008.

Reprints or correspondence: Dr. Maria C. Rodriguez-Barradas, Michael E. DeBakey VAMC, 2002 Holcombe Blvd. (MS 111G), Houston, TX 77030 ().

Cited by

Ole S. Sogaard, Nicolai Lohse, and Lars Ostergaard. (2008) Confounding May Lead to Overestimation of Pneumococcal Polysaccharide Vaccine Effectiveness among HIV-Infected Individuals. Clinical Infectious Diseases 47:2, 294-295
Online publication date: 15-Jul-2008.
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