Meningococcal Disease Risk 10-Fold Higher in People With HIV

Yael Waknine

October 30, 2013

People living with AIDS/HIV (PLWHA) are at 10-fold increased risk for contracting invasive meningococcal disease (IMD), according to a 12-year epidemiologic study published online October 29 in the Annals of Internal Medicine.

Matching population-based IMD surveillance data with HIV and vital statistic registries in New York City, Laura Miller, MPH, from the New York City Department of Health and Mental Hygiene, Queens, and colleagues found an annual incidence rate of 3.4 per 100,000 for PLWHA aged 15 to 64 years compared with 0.34 for their AIDS/HIV-negative counterparts (relative risk [RR], 10.0; 95% confidence interval [CI], 7.2 - 14.1).

According to the authors, prior studies had failed to elucidate the connection because of the relatively limited lifespan of PLWHA before the advent of highly active antiretroviral therapy.

"Our findings, and those of the [Centers for Disease Control and Prevention], suggest that in the era of [highly active antiretroviral therapy], PLWHA are at a higher risk of IMD than the general population," the authors write, citing Centers for Disease Control and Prevention data that demonstrate an even greater 13-fold increase in risk.

Overall, 263 cases of IMD and 55 deaths were reported among New York City residents aged 15 to 64 years during 2000 to 2011; 40 cases (15%) and 4 deaths occurred in PLWHA. IMD was 5.3 times (95% CI, 1.4 - 20.4 times) more common among PLWHA with CD4+ counts lower than 200 × 109 cells/L than in those with higher counts; median time from HIV diagnosis to IMD infection was 6.5 years (range, 0.0 - 15.2 years).

Almost 90% of IMD cases among PLWHA could have been prevented with a tetravalent meningococcal vaccine approved by the US Food and Drug Administration in 2005; 35 of 38 cases with available data showed the presence of serogroups A, C, Y, or W135.

However, recommended use of the vaccine, known as MCV4, is currently limited to young adolescents aged 11 to 12 years, based on a cost-efficacy analysis demonstrating benefit in preventing the spread of IMD among college students living in close quarters.

"Cost effectiveness and vaccine efficacy studies are needed in order to evaluate the value of a national recommendation for routine meningococcal vaccination of PLWHA," the authors emphasize.

Such studies would be particularly useful, as further analysis revealed that most IMD cases occurred among older PLWHA: only 2 of 40 cases (5%) occurred among those aged 15 to 24 years. The remaining 38 cases were distributed almost evenly among PLWHA aged 25 to 44 years and 45 to 64 years, respectively (20 cases [50%] and 18 cases [45%]).

"PLWHA aged 15–24 years [are] at the highest risk for IMD," the authors point out, noting that the severe disease can lead to long-term disability and death. "We believe that these data support extending the current meningococcal vaccine recommendation for HIV-infected adolescents into early adulthood before HIV-associated immune senescence impairs immune function," the authors conclude.

The study was funded by the New York City Tax Levy and the Epidemiology and Laboratory Capacity for Infectious Diseases grant of the Centers for Disease Control and Prevention.

Ann Intern Med. Published online October 29, 2013. Abstract

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