Declining incidence of invasive Streptococcus pneumoniae infections among persons with AIDS in an era of highly active antiretroviral therapy, 1995-2000

J Infect Dis. 2005 Jun 15;191(12):2038-45. doi: 10.1086/430356. Epub 2005 May 11.


Background: Our goal was to describe trends in invasive pneumococcal disease incidence among persons with acquired immunodeficiency syndrome (AIDS) since the introduction of highly active antiretroviral therapy (HAART).

Methods: We used time-trend analysis of annual invasive pneumococcal disease incidence rates from a population-based, active surveillance system. Annual incidence rates were calculated for 5 July-June periods by use of data from San Francisco county, the 6-county Baltimore metropolitan area, and Connecticut. The numerators were the numbers of invasive Streptococcus pneumoniae infections among persons 18-64 years of age with AIDS; the denominators were the numbers of persons living with AIDS, estimated on the basis of AIDS surveillance data.

Results: The annual incidence of invasive pneumococcal disease declined from 1094 cases/100,000 persons with AIDS (July 1995-June 1996) to 467 cases/100,000 persons living with AIDS (July 1999-June 2000). The annual percentage changes in incidence were -34%, -29%, -8%, and -1%. Declines were similar by surveillance area, sex, and race/ethnicity. During the final year of the study, the invasive pneumococcal disease incidence in persons with AIDS was half that of the pre-HAART era but was still 35 times higher than that in similarly aged non-HIV-infected adults.

Conclusions: In the United States, invasive pneumococcal disease incidence declined sharply across a range of subgroups living with AIDS during the period after widespread introduction of HAART. Despite these gains, persons with AIDS remain at high risk for invasive pneumococcal disease.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • AIDS-Related Opportunistic Infections / epidemiology*
  • AIDS-Related Opportunistic Infections / ethnology
  • Acquired Immunodeficiency Syndrome / drug therapy
  • Adolescent
  • Adult
  • Antiretroviral Therapy, Highly Active*
  • Black or African American
  • Female
  • Hispanic or Latino
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Pneumococcal Infections / epidemiology*
  • Pneumococcal Infections / ethnology
  • Retrospective Studies
  • United States / epidemiology
  • White People