Incidence, Clinical Features and Vaccination Coverage of Pneumococcal Disease in People Living with HIV: A Retrospective Cohort Study (2015-2024).

Introduction

The incidence of pneumococcal disease (PD) in people living with HIV (PLWH) is higher than in the general population; therefore, this study aimed to analyze its incidence, clinical characteristics and vaccination coverage in PLWH.

Methods

We conducted a retrospective, single-center study between 2015 and 2024 in Hospital Clínic, Barcelona, involving HIV patients who presented with PD during the study period (any patient with a microbiologically confirmed result). A descriptive analysis of cases was carried out and compared with patients who did not present PD during the study period.

Results

A total of 177 episodes of PD were identified in 148 individuals, with a cumulative incidence of 1.7% (95% CI: 1.4-2.0). The median age at PD diagnosis was 45.9 (36-53) years; 64% of patients were Spanish-born; 50% of patients were men who have sex with men (MSM); the HIV transmission mode was intravenous drug use in 28% of cases; the median CD4 nadir was 181 (58-324) cells/mm3; the median CD4 prior to PD was 429 (240-663) cells/mm3; and the median peak HIV viral load (VL) was 176,839 (20,900-502,000) copies/mL. Intravenous drug use (OR 3.43; 95% CI 2.19-5.36; p < 0.001), peak HIV VL (OR 1.11; 95% CI 1.02-1.21; p = 0.011), and CD4 nadir (OR 0.92; 95% CI 0.87-0.98; p = 0.005) were independently associated with PD, and fifty-one percent of patients had not received any vaccination prior to their PD episode.

Conclusion

PD incidence was high in our study and associated with poor immunological status. Research on new strategies to improve vaccination coverage and immunogenicity in PLWH is needed.