Increased risk of invasive meningococcal disease for patients with HIV

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1. People living with HIV/AIDS had a 10 times higher relative risk of developing invasive meningococcal disease. 

Evidence Rating Level: 4 (Below Average) 

Study Rundown: Human immunodeficiency virus (HIV), the infectious agent responsible for acquired immunodeficiency syndrome (AIDS), leads to decreased immunity and increased susceptibility of a multitude of opportunistic infections.  Thus far, the association between invasive meningococcal disease (IMD) and HIV/AIDs has been suggested.  However, this relationship has not been fully defined in the current era of Highly Active Antiretroviral Therapy (HAART).  Establishment of this association could be used for developing recommendations for meningococcal vaccines in this patient population.  This recent study, conducted in New York City, compared the rates of IMD in patients with HIV/AIDs compared to uninfected patients.  The results found that patients with HIV/AIDS had a 10 times higher risk than those uninfected individuals to develop IMD.  Furthermore, among patients with HIV/AIDs, those who developed IMD were around 5 times more likely to have a CD4+ count of less than 200×109c cells/L.  This study provides evidence that patients with HIV/AIDs are at high risk of IMD, and that this patient population may benefit from routine meningococcal vaccination.

Click to read the study, published today in the Annals of Internal Medicine

Relevant Reading: Bacterial infections in adult patients with acquired immune deficiency syndrome (AIDS) and AIDS-related complex

In-Depth [cross-sectional study]:  The study included IMD cases between the ages of 15-64 reported in New York City (NYC) between the dates of 2000-2011.  Patient’s HIV status was determined using the NYC HIV Surveillance Registry (HSR).  The IMD surveillance cases were matched to the death and HSR to determine IMD risk and case fatality ratios.  The study also looked at a subset of patients who had a CD4 and viral load measurement near the time of death to be included in a age-matched, case-control analysis to determine the association between these HIV markers and IMD risk.  It was found that patients with HIV/AIDS had a 3.4 per 100,000 annual incidence rate compared to 0.34 per 100,000 for those patients without HIV/AIDS.  Therefore, patients with HIV/AIDS had a 10.0 (95% confidence interval, 7.2-14.1) relative risk for invasive meningococcal disease.  Furthermore, among patients with HIV/AIDs, those who developed IMD were around 5.3 more likely (95% CI, 1.4-20.4) to have a CD4+ count of less than 200×109c cells/L. It was also found that the risk of invasive meningococcal disease was higher in male AIDS/HIV cases 12.2 (95% CI, 8.1-18.5) vs. 7.6 (95% CI, 4.0-14.5) for HIV infected women.

By Adam Whittington and Aimee Li, MD

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