Among PLWH, rates of invasive pneumococcal disease and community-acquired pneumonia remain considerably higher than among the general population, a Dutch study reported in Clinical Infectious Diseases showed.
The examination of pneumonia cases in Dutch PLWH focused on a period beginning in June 2008 and ending in December 2017, thus encompassing recent improvements in HIV treatment within a high-income country. Nonetheless, the study found that PLWH were diagnosed with invasive pneumococcal disease at a rate more than seven times higher than the Dutch population as a whole, and were diagnosed with community-acquired pneumonia at a rate more than eight times higher.
Lung infection rates were higher among PLWH with lower CD4 counts but continued to exceed general population rates even at CD4 cell counts > 500 cells/µL (PLWH: 946/100,000 patient years of follow up compared to 188/100,000 in the Dutch population). Such higher risk may be related to persistent humoral immune defects that limit the body’s protection against capsulated bacteria in PLWH, study authors theorized, as well as due to lifestyle factors, such as smoking.
Although vaccinating all PLWH against pneumococcal infection is recommended internationally, guidelines in the Netherlands suggest such vaccinations only if there are additional risk factors. The study authors recommended expanding pneumococcal vaccination in the Netherlands in line with international recommendations.
However, a commentary published alongside the Dutch study pushes against the suggestion that pneumococcal vaccination be expanded in the Netherlands. Elizabeth R. Jenny-Avital, M.D., of the Jacobi Medical Center in New York City discussed two common vaccines and their respective effectiveness in certain populations, concluding that “Many questions regarding the deployment [of] pneumococcal vaccine in people living with HIV and other high-risk patients remain, including optimal timing, frequency, adjuvant, and surrogates of protection.” Meanwhile, providers should address modifiable risks, such as smoking, and test everyone with a pneumococcal infection for HIV, she advised.