Elsevier

The Lancet

Volume 347, Issue 9003, 16 March 1996, Pages 718-723
The Lancet

Article
Invasive pneumococcal disease in a cohort of predominantly HIV-1 infected female sex-workers in Nairobi, Kenya

https://doi.org/10.1016/S0140-6736(96)90076-8Get rights and content

Abstract

Summary

Background HIV infection is a major risk factor for pneumococcal disease in industrialised countries. Although both are common infections in sub-Saharan Africa, few studies have investigated the importance of this interaction. We have followed up a cohort of female sex-workers in Nairobi and report here on the extent of invasive pneumococcal disease.

Methods A well-established cohort of low-class female sex-workers, based around a community clinic, was followed up from October, 1989, to September, 1992. 587 participants were HIV positive and 132 remained HIV negative. Set protocols were used to investigate common presentations. Cases were identified clinically and radiographically. Streptococcus pneumoniae and other pathogens were diagnosed by culture.

Findings Seventy-nine episodes of invasive pneumococcal disease were seen in the 587 HIV-positive women compared with one episode in the 132 seronegative women (relative risk 17·8, 95% Cl 2·5 to 126·5). In seropositive women the incidence rate was 42·5 per 1000 person-years and the recurrence rate was 264 per 1000 person-years. By serotyping, most recurrent events were re-infection. A wide spectrum of HIV-related pneumococcal disease was seen: only 56% of cases were pneumonia; sinusitis was seen in 30% of cases, and occult bacteraemia, a novel adult presentation, in 11%. Despite forty-two bacteraemic episodes, no deaths were attributable to Strep pneumoniae. At first presentation the mean CD4 cell count was 302/μL (SD 191) and was 171/μL (105) for recurrent episodes. During acute Strep pneumoniae infection the CD4 cell count was reversibly suppressed (mean fall in sixteen episodes, 105/μL [123]). The neutrophil response to acute infection was blunted and was correlated with CD4 count (r=0·50, 95% Cl 0·29 to 0·66). Strep pneumoniae caused more disease, at an earlier stage of HIV immunosuppression, than Mycobacterium tuberculosis or non-typhi salmonellae.

Interpretation Our study highlights the importance of the pneumococcus as an early but readily treatable complication of HIV infection in sub-Saharan Africa.

References (31)

  • Cf Gilks et al.

    A case-control study of HIV and pneumococcal pneumonia in Kenyatta National Hospital, Nairobi

    (1993)
  • K. Pallangyo et al.

    High HIV seroprevalence and increased HIV-associated mortality among hospitalized patients with deep bacterial infections in Dar es Salaam, Tanzania

    AIDS

    (1992)
  • Jn Simonsen et al.

    HIV infection among lower socioeconomic strata prostitutes in Nairobi

    AIDS

    (1990)
  • Ghc Mientjes et al.

    Clinical symptoms associated with seroconversion for HIV-1 among misusers of intravenous drugs: comparison with homosexual seroconverters and infected and non-infected intravenous drug misusers

    BMJ

    (1993)
  • Dj Barnes et al.

    The role of percutaneous lung aspiration in the bacteriological diagnosis of pneumonia in adults

    Aust NZ J Med

    (1988)
  • Cited by (0)

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