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Incidence of Pneumococcal and Varicella Disease in HIV-infected Children and Adolescents in the United Kingdom and Ireland, 1996–2011

Payne, Helen MB ChB, MRCPCH*; Judd, Ali PhD; Donegan, Katherine PhD; Okike, Ifeanyichukwu O. MRCPCH; Ladhani, Shamez N. MRCPCH, PhD*‡§; Doerholt, Katja MB ChB, MRCPCH*†; Heath, Paul T. MRCPCH, PhD

Pediatric Infectious Disease Journal: February 2015 - Volume 34 - Issue 2 - p 149–154
doi: 10.1097/INF.0000000000000476
HIV Reports

Background: To define the burden of hospitalization due to 2 vaccine-preventable infections, invasive pneumococcal disease (IPD) and varicella zoster (VZ), among HIV-infected children in the UK and Ireland.

Methods: Analysis of hospitalizations of HIV-infected children <18 years receiving pediatric care and reported to the Collaborative HIV Paediatric Study (CHIPS) between 1996 and 2011.

Results: Admissions for IPD and VZ combined accounted for ~5% of all hospital admissions for HIV-infected children each year. When compared with background rates for healthy children, the admission rate ratio for HIV-infected children on combination antiretroviral therapy (cART) was 16.7, 14.8 and 126.7 for IPD, varicella and herpes zoster, respectively, and 156.7, 86.1 and 470, respectively, for HIV-infected children not on cART. Those admitted with IPD or VZ were more likely to have Centers for Disease Control stage B/C at presentation with HIV than those without such admissions (36.8% for IPD, 29.7% for VZ and 22.1% for no IPD or VZ, P = 0.006), and were more likely to subsequently commence cART (94.7%, 91.3% and 80.2% respectively, P = 0.004).

Conclusions: There is a clear increased risk of admission with IPD or VZ in HIV-infected compared with uninfected children, magnified in those who have not yet commenced cART. It is anticipated that the introduction of new guidelines will result in improved vaccine uptake and thereby reduce the burden of IPD and VZ disease. Subsequent evaluation will assess the impact of these guidelines.

From the *Pediatric Infectious Diseases Unit, St Georges Healthcare NHS Trust, London, United Kingdom; Medical Research Council Clinical Trials Unit at UCL, London, United Kingdom; Clinical Sciences and Vaccine Institute, St Georges, University of London, London, United Kingdom; and §Public Health England, Colindale, London, United Kingdom.

Accepted for publication June 5, 2014.

Supported by the National Study of HIV in Pregnancy and Childhood receives core funding from the Health Protection Agency. The Collaborative HIV Paediatric Study is funded by the NHS (London Specialized Commissioning Group) and has received additional support from Bristol-Myers Squibb, Boehringer Ingelheim, GlaxoSmithKline, Roche, Abbott and Gilead Sciences. The views expressed in the publication are those of the authors and not necessarily those of the Health Protection Agency, the London NHS Specialized Commissioning Group, the Medical Research Council, or any additional funders.

The authors have no conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.pidj.com).

Address for correspondence: Helen Payne, MB ChB, MRCPCH, St Georges' Hospital, c/o Comfrey Cottage, Oxborough Road, Boughton, Norfolk PE33 9AH, United Kingdom. E-mail: helenpayne@doctors.org.uk.

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