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Pneumococcal Disease and HIV Infection
- Charles F. Gilks, MD
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TO THE EDITOR:
Janoff and colleagues [1] are to be congratulated on a clear and comprehensive review of the importance of the interaction of HIV infection with Streptococcus pneumoniae. Despite the extent of pneumococcal infection worldwide and its associated mortality and morbidity at all ages, only a few such studies (mostly small or retrospective) have been published.
Pneumococcal infection is particularly important in Africa, where HIV infection is so prevalent. We have been studying high-grade (nonopportunistic) bacterial infections in Nairobi for several years. Streptococcus pneumoniae is the leading cause of bacteremia in HIV-seronegative adults admitted to the hospital and is strongly associated with HIV infection [2].
In a large cohort of lower socioeconomic class female prostitutes in Nairobi during a 2-year period, we found that invasive pneumococcal disease was the most frequently encountered serious HIV-associated infection, even more common than tuberculosis [3]. As expected, disease presentation was early (mean CD4 count, 325/mm3), and many women (22%) developed reinfection. Under the optimal conditions of a community-based research clinic, no patients died despite the fact that 29 episodes were bacteremic. In a more typical general hospital setting, however, mortality from pneumococcal pneumonia may be higher in HIV-infected adults [4].
Few studies in Africa have investigated comprehensively the clinical problems of the HIV-infected adult. Because of insufficient bacteriology laboratories, the interaction with the pneumococcus, as well as with non-typhi salmonellae, has therefore largely been missed [5]. Yet, these pathogens are treatable with readily available and affordable antibiotics.
The authoritative review by Janoff and colleagues may help to increase awareness of the importance of the pneumococcus globally and may stimulate much needed research into both disease and prevention. The pneumococcus remains the only important HIV-associated pathogen for which an effective and licensed vaccine is available. The question remains: Will it work in Africa?
Charles F. Gilks
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
