Invasive Pneumococcal Disease in People Living with HIV: A Retrospective Case—Control Study in Brazil
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
4.1. Risk Factors for IPD
4.2. CD4, ART, and IPD
4.3. Clinical and Laboratory Abnormalities and IPD
4.4. Mortality and IPD
4.5. Antimicrobial Sensitivity
4.6. Pneumococcal Vaccine and HIV
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | All Patients (n = 153) | IPD (n = 45) | No IPD (n = 108) | p-Value | |
---|---|---|---|---|---|
Median [IQR] or n (%) | Median [IQR] or n (%) | Median [IQR] or n (%) | |||
Age (years) | 42 [35;48] | 41 [35;47] | 42 [35;48] | 0.862 | |
Sex at birth | Male | 99 (64.7%) | 28 (62.2%) | 71 (65.7%) | 0.819 |
Female | 54 (35.3%) | 17 (37.8%) | 37 (34.3%) | ||
Race/color | Black | 41 (26.8%) | 13(28.9%) | 28 (25.9%) | 0.891 |
Brown | 64 (41.8%) | 19 (42.2%) | 45 (41.7%) | ||
White | 48 (31.4%) | 13 (28.9%) | 35 (32.4%) | ||
Education | Primary education | 58 (39.5%) | 15 (35.7%) | 43 (41%) | 0.689 |
Secondary and higher education | 89 (60.5%) | 27 (64.3%) | 62 (59%) | ||
Smoking | Yes | 61 (41.8%) | 22 (48.9%) | 39 (38.6%) | 0.327 |
Drinking | Yes | 47 (32%) | 16 (35.6%) | 31 (30.4%) | 0.67 |
Drug use | Cocaine/Crack | 33 (22.9%) | 15 (33.3%) | 18 (18.2%) | 0.107 |
Cannabis | 8 (5.6%) | 3 (6.7%) | 5 (5.1%) | ||
COPD | Yes | 24 (15.8%) | 13 (28.9%) | 11 (10.3%) | 0.009 |
DM | Yes | 8 (5.3%) | 4 (8.9%) | 4 (3.7%) | 0.368 |
Liver cirrhosis | Yes | 15 (9.8%) | 9 (20%) | 6 (5.6%) | 0.015 |
Steroid use | Yes | 8 (5.2%) | 3 (6.7%) | 5 (4.6%) | 0.907 |
Monthly family income | Up to 3 mw | 138 (90.2%) | 41 (91.1%) | 97 (89.8%) | 1 |
>3 mw | 15 (9.8%) | 4 (8.9%) | 11 (10.2%) | ||
Newly diagnosed HIV | 28(18.3%) | 4(8.9%) | 24 (22.2%) | 0.087 | |
Nadir(cells/mm3) | Nadir | 110 [28;275] | 117.5 [49.3;316.8] | 110 [27;272] | 0.606 |
CD4 (cells/mm3) | CD4 | 165 [53.75;418.25] | 267.5 [96.5;495.25] | 140 [34;376.75] | 0.027 |
CD4 strata (cells/mm3) | <100 | 54 (37%) | 12 (27.3%) | 42 (41.2%) | 0.025 |
100–200 | 27 (18.5%) | 5 (11.4%) | 22 (21.6%) | ||
>200 | 64 (44.5%) | 27 (61.4%) | 38 (37.3%) | ||
CD4/CD8 | CD4/CD8 | 0.32 [0.09;0.59] | 0.4 [0.14;0.68] | 0.28 [0.08;0.58] | 0.36 |
Viral load (copies/mL) | 1497 [39;79403.75] | 793 [39;24821] | 2204 [39;158616] | 0.311 | |
ART | Yes | 120 (78.4%) | 40 (88.9%) | 80 (74.1%) | 0.07 |
Prophylaxis for OI | Yes | 69 (45.1%) | 27 (60%) | 42 (38.9%) | 0.027 |
PPV23 | Yes | 29 (19%) | 9 (20%) | 20 (18.5%) | 1 |
PCV13 | Yes | 1 (0.7%) | 1 (2.2%) | 0 (0%) | 0.65 |
Physical Signs and Laboratory Features | All Groups (n = 163) | IPD (n = 55) | No IPD (n = 108) | p-Value |
---|---|---|---|---|
Median [IQR] | Median [IQR] | Median [IQR] | ||
Systolic blood pressure (mmHg) | 110 [100;120] | 100 [90;110] | 110 [100;120] | <0.001 |
Diastolic blood pressure (mmHg) | 60 [60;80] | 60 [60;70] | 70 [60;80] | 0.002 |
MAP (mmHg) | 80 [73.33;90] | 73.33 [66.67;83.33] | 83.33 [73.33;93.33] | <0.001 |
HR | 101 [86;120] | 112 [93;124.5] | 97 [82;114] | 0.014 |
RR | 20.5 [19;27] | 25 [20.5;28.5] | 20 [18;24] | <0.001 |
Temperature | 37 [36.1;38.08] | 37.65 [36.53;38.88] | 36.8 [36;38] | 0.019 |
Room SPO2 | 97 [92.75;98] | 95 [90;97] | 98 [94.5;99] | 0.008 |
BMI (kg/m2) | 20.3 [17.95;23.7] | 21.3 [18.6;24.9] | 19.6 [17.93;23.53] | 0.349 |
Hemoglobinlevels (g/dL) | 10.8 [9;12.9] | 10.75 [9.15;12] | 10.9 [8.95;13.35] | 0.447 |
Platelets (10³/mm³) | 224 [157;293] | 214 [151.75;297.5] | 232 [168.5;284.5] | 0.791 |
Leukocytes (103/mm3) | 7300 [4645;12,535] | 12675 [8680;15,395] | 6180 [4055;8550] | <0.001 |
Bands (%) | 5 [2;10.75] | 7.5 [4.75;15.25] | 3 [2;8.75] | <0.001 |
Segmented Neutrophils (%) | 70 [58;77] | 72 [63.5;80] | 65.5 [55.25;76] | 0.017 |
Lymphocytes (%) | 14 [8;24] | 8.5 [5.75;14.25] | 17 [11;30] | <0.001 |
Creatinine (mg/dL) | 1.04 [0.8;1.64] | 1.64 [1.08;2.55] | 0.96 [0.76;1.29] | <0.001 |
Urea (mg/dL) | 33 [25;54] | 51.5 [30;96.5] | 32 [22;43] | <0.001 |
AST (IU/L) | 34 [25;61.25] | 48.2 [25;70.75] | 33 [25;50] | 0.07 |
ALT (IU/L) | 31.8 [25;50.75] | 30.5 [24.25;46.75] | 33.5 [25;52.25] | 0.408 |
Total Bilirubin (mg/dL) | 0.49 [0.28;0.86] | 0.57 [0.34;1.26] | 0.44 [0.27;0.8] | 0.074 |
Albumin (g/L) | 2.3 [1,9;2,98] | 2.1 [1,8;2.6] | 2.6 [2;3.1] | 0.013 |
Sodium (mEq/L) | 134 [130;138] | 133 [130;136.5] | 135 [132;138] | 0.061 |
CRP levels (mg/dL) | 9.2 [3.14;20.33] | 22 [10.45;28.67] | 5.77 [1.14;11.51] | <0.001 |
Variables | Level | IPD | OR (CI95%) | p-Value | aOR (CI95%) | p-Value | |
---|---|---|---|---|---|---|---|
Yes (n = 45) | No (n = 108) | ||||||
BMI (kg/m2) | >18 | 6 (28.57%) | 22 (28.95%) | Ref. | Ref. | Ref. | Ref. |
19–25 | 12 (57.14%) | 42 (55.26%) | 1.05 (0.35–3.17) | 1 | 1.99 (0.38–10.3) | 0.828 | |
>26 | 3 (14.29%) | 12 (15.79%) | 0.92 (0.19–4.34) | 1 | 1.59 (0.15–16.57) | 0.828 | |
MAP (mmHg) | >70 | 26 (61.9%) | 87 (84.47%) | 0.3 (0.13–0.68) | 0.003 | 0.17 (0.05–0.53) | 0.002 |
HR | >90 | 32 (78.05%) | 60 (60.61%) | 2.31 (1–5.37) | 0.051 | 2.51 (0.78–8.1) | 0.123 |
RR | >22 | 28 (68.29%) | 30 (31.58%) | 4.67 (2.12–10.25) | 0.000 | 4.79 (1.5–15.29) | 0.008 |
Hemoglobin (g/dL) | >10 | 27 (61.36%) | 67 (63.21%) | 0.92 (0.45–1.91) | 0.831 | 1 (0.3–3.28) | 0.998 |
CRP (mg/dL) | >10 | 17 (73.91%) | 21 (31.34%) | 6.21 (2.14–17.99) | 0.000 | 9.16 (1.98–42.38) | 0.004 |
Platelets (10³/mm³) | >225 | 19 (43.18%) | 55 (51.89%) | 0.7 (0.35–1.43) | 0.332 | 0.24 (0.08–0.72) | 0.011 |
Leukocytes (103/mm3) | >7300 | 33 (76.74%) | 37 (34.91%) | 6.15 (2.73–13.87) | <0.000 | 3.45 (1.12–10.56) | 0.030 |
Bands (%) | >6 | 30 (71.43%) | 36 (34.29%) | 4.79 (2.19–10.47) | <0.000 | 4.14 (1.36–12.63) | 0.012 |
Segmented Neutrophils (%) | >70 | 21 (50%) | 43 (40.95%) | 1.44 (0.7–2.96) | 0.318 | 3.24 (1.07–9.76) | 0.037 |
Lymphocytes (%) | >15 | 12 (28.57%) | 64 (60.95%) | 0.26 (0.12–0.56) | 0.000 | 0.09 (0.02–0.37) | <0.001 |
Creatinine (mg/dL) | >1 | 32 (76.19%) | 38 (35.85%) | 5.73 (2.54–12.92) | 0.000 | 9.52 (2.88–31.45) | <0.001 |
Urea (mg/dL) | >33 | 27 (67.5%) | 42 (39.62%) | 3.16 (1.47–6.82) | 0.003 | 3.83 (1.24–11.81) | 0.019 |
Bilirubin (mg/dL) | >0.50 | 24 (66.67%) | 44 (43.56%) | 2.59 (1.17–5.75) | 0.019 | 4.19 (1.23–14.25) | 0.021 |
Albumin (g/L) | >2.3 | 8 (33.33%) | 35 (56.45%) | 0.39 (0.14–1.03) | 0.058 | 0.05 (0–0.63) | 0.020 |
Variables | Level | IPD | OR (CI95%) | p-Value | aOR (CI95%) | p-Value | |
---|---|---|---|---|---|---|---|
Yes (n = 45) | No (n = 108) | ||||||
Sex at birth | Female | 17 (37.78%) | 37 (34.26%) | 1.17 (0.57–2.4) | 0.678 | 1.55 (0.56–4.31) | 0.397 |
Smoking | Yes | 22 (48.89%) | 39 (38.61%) | 1.52 (0.75–3.09) | 0.246 | 1.84 (0.65–5.18) | 0.250 |
Drinking | Yes | 16 (35.56%) | 31 (30.39%) | 1.26 (0.6–2.65) | 0.536 | 1.89 (0.68–5.29) | 0.223 |
Drug use | Cocaine/crack | 15 (33.33%) | 18 (18.18%) | 2.35 (1.04–5.29) | 0.080 | 1.5 (0.49–4.58) | 0.956 |
Cannabis | 3 (6.67%) | 5 (5.05%) | 1.69 (0.38–7.55) | 0.492 | NC | NC | |
COPD | Yes | 13 (28.89%) | 11 (10.28%) | 3.55 (1.45–8.7) | 0.005 | 2.88 (0.79–10.54) | 0.109 |
DM | Yes | 4 (8.89%) | 4 (3.74%) | 2.51 (0.6–10.52) | 0.207 | 2.38 (0.31–18.11) | 0.403 |
Liver cirrhosis | Yes | 9 (20%) | 6 (5.56%) | 4.25 (1.41–12.78) | 0.009 | 3.58 (0.7–18.22) | 0.125 |
Steroid use | Yes | 3 (6.67%) | 5 (4.63%) | 1.47 (0.34–6.44) | 0.607 | 0.39 (0.04–4.12) | 0.430 |
New case HIV | Yes | 4 (8.89%) | 24 (22.22%) | 0.34 (0.11–1.05) | 0.060 | NC | NC |
ART Use | No | 5 (11.11%) | 28 (25.93%) | 0.36 (0.13–0.99) | 0.049 | 0.66 (0.11–3.9) | 0.644 |
CD4 (cells/mm3) | <100 | 12 (27.27%) | 42 (41.18%) | Ref. | Ref. | Ref. | Ref. |
100–200 | 5 (11.36%) | 22 (21.57%) | 0.8 (0.25–2.55) | 0.699 | 0.41 (0.07–2.42) | 0.655 | |
>200 | 27 (61.36%) | 38 (37.25%) | 2.49 (1.11–5.59) | 0.055 | 1.46 (0.24–8.95) | 0.683 | |
Prophylaxis for OI | Yes | 27 (60%) | 42 (38.89%) | 2.36 (1.16–4.8) | 0.018 | 2.86 (0.87–9.36) | 0.082 |
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Mamani, R.F.; López, T.d.A.; Jalo, W.M.; Alves, M.R.; Nunes, E.P.; Pereira, M.S.; Silva, E.A.d.S.R.d.; Lourenço, M.C.d.S.; Veloso, V.G.; Grinsztejn, B.J.; et al. Invasive Pneumococcal Disease in People Living with HIV: A Retrospective Case—Control Study in Brazil. Trop. Med. Infect. Dis. 2023, 8, 328. https://doi.org/10.3390/tropicalmed8060328
Mamani RF, López TdA, Jalo WM, Alves MR, Nunes EP, Pereira MS, Silva EAdSRd, Lourenço MCdS, Veloso VG, Grinsztejn BJ, et al. Invasive Pneumococcal Disease in People Living with HIV: A Retrospective Case—Control Study in Brazil. Tropical Medicine and Infectious Disease. 2023; 8(6):328. https://doi.org/10.3390/tropicalmed8060328
Chicago/Turabian StyleMamani, Roxana Flores, Tiago de Assunção López, Waldir Madany Jalo, Marcelo Ribeiro Alves, Estevão Portela Nunes, Mario Sérgio Pereira, Erica Aparecida dos Santos Ribeiro da Silva, Maria Cristina da Silva Lourenço, Valdiléa Gonçalves Veloso, Beatriz Jegerhorn Grinsztejn, and et al. 2023. "Invasive Pneumococcal Disease in People Living with HIV: A Retrospective Case—Control Study in Brazil" Tropical Medicine and Infectious Disease 8, no. 6: 328. https://doi.org/10.3390/tropicalmed8060328