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Epidemiologic Relation between HIV and Invasive Pneumococcal Disease in San Francisco County, California

J. Pekka Nuorti, MD; Jay C. Butler, MD; Lisa Gelling, MPH; Jacob L. Kool, MD, MS; Arthur L. Reingold, MD; and Duc J. Vugia, MD, MPH
[+] Article and Author Information

From the California State Department of Health Services, California Emerging Infections Program, and the University of California at Berkeley, Berkeley, California; and the National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.


Note: This paper was presented in part at the 35th Annual Meeting of the Infectious Disease Society of America, San Francisco, California, 13-16 September 1997.

Grant Support: Pneumococcal surveillance was funded by the National Center for Infectious Diseases Emerging Infections Program and the National Vaccine Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia.

Acknowledgments: The authors thank the following persons for their assistance in the investigation: Ling Hsu, San Francisco Department of Public Health, AIDS Office, San Francisco, California; Gretchen Rothrock, California Emerging Infections Program, Berkeley, California; Richard Facklam, Robert Breiman, Margarette Kolczak, Ariane Kraus, David Keller, Brian Plikaytis, and Anne Schuchat, Centers for Disease Control and Prevention, Atlanta, Georgia.

Requests for Single Reprints: J. Pekka Nuorti, MD, Department of Infectious Disease Epidemiology, National Public Health Institute, Mannerheimintie 166, FIN-00300 Helsinki, Finland; e-mail, pekka.nuorti@ktl.fi.

Requests To Purchase Bulk Reprints (minimum, 100 copies): the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints@mail.acponline.org.

Current Author Addresses: Dr. Nuorti: Department of Infectious Disease Epidemiology, National Public Health Institute, Mannerheimintie 166, FIN-00300 Helsinki, Finland.

Dr. Butler: Arctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, 4055 Tudor Centre Drive, Anchorage, AK 99508-5902.

Ms. Gelling: California Emerging Infections Program, 703 Market Street, Suite 705, San Francisco, CA 94103.

Dr. Kool: Department of Infectious Disease Epidemiology (CIE), RIVM, Postbak 75, A van Leeuwenhoeklaan 9, 3720 BA Bilthoven, the Netherlands.

Dr. Reingold: Division of Public Health Biology and Epidemiology, Earl Warren Hall, University of California, Berkeley, Berkeley, CA 94720-7360.

Dr. Vugia: Division of Communicable Disease Control, State of California, Department of Health Services, 2151 Berkeley Way, Berkeley, CA 94704-1011.

Author Contributions: Conception and design: J.P. Nuorti, A. Reingold, D.J. Vugia.

Analysis and interpretation of the data: J.P. Nuorti, J.C. Butler, J.L. Kool, D.J. Vugia.

Drafting of the article: J.P. Nuorti, J.C. Butler.

Critical revision of the article for important intellectual content: J.P. Nuorti, J.C. Butler, J.L. Kool, A. Reingold, D.J. Vugia.

Final approval of the article: J.P. Nuorti, J.C. Butler, L.B. Gelling, J.L. Kool, A. Reingold, D.J. Vugia.

Statistical expertise: J.P. Nuorti, J.C. Butler, J.L. Kool.

Obtaining of funding: A. Reingold, D.J. Vugia.

Administrative, technical, or logistic support: J.C. Butler, L.B. Gelling, A. Reingold, D.J. Vugia.

Collection and assembly of data: J.P. Nuorti, L.B. Gelling, D.J. Vugia.


Ann Intern Med. 2000;132(3):182-190. doi:10.7326/0003-4819-132-3-200002010-00003
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S treptococcus pneumoniae is the leading cause of community-acquired bacterial pneumonia and bacteremia in HIV-infected persons (13). Persons infected with HIV currently account for at least 40% of all adult cases of invasive pneumococcal disease in many U.S. medical centers (45). Pneumococcal disease can occur early in the course of HIV infection, before onset of other opportunistic infections specifically associated with AIDS (68), and recurrent infection is common (2, 8). Extremely high overall rates of invasive disease have been documented in persons with AIDS (6, 89), but no detailed data are available on disease rates in different demographic groups.

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Figure 1.
Incidence of invasive pneumococcal disease by age, sex, and ethnicity (San Francisco, California, 1995-1996).

Black squares represent incidence among black persons, white squares represent incidence among nonblack persons, black circles represent incidence among men, and white circles represent incidence among women.

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Figure 2.
Incidence of invasive pneumococcal disease among persons with AIDS and those without known HIV infection by quarter/year of diagnosis (San Francisco, California, October 1994 through June 1997).

Black squares represent incidence among persons with AIDS, and white squares represent incidence among persons without known HIV infection. Points represent quarterly incidence. Rates for patients with AIDS are shown per 1000 person-years. For persons without known HIV infection, rates are shown per 10 000 person-years.

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Summary for Patients

Human Immunodeficiency Virus (HIV) and Invasive Pneumococcal Infections

The summary below is from the full report titled “Epidemiologic Relation between HIV and Invasive Pneumococcal Disease in San Francisco County, California.” It is in the 1 February 1999 issue of Annals of Internal Medicine (volume 132, pages 182-190). The authors are J.P. Nuorti, J.C. Butler, L. Gelling, J.L. Kool, A.L. Reingold, and D.J. Vugia.

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