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Titolo:
Is the recommendation for pneumococcal vaccination of HIV patients evidence based?
Autore:
Pierce, AB; Hoy, JF;
Indirizzi:
Alfred Hosp, Clin Res Sect, Dept Infect Dis, Prahran, Vic 3181, Australia Alfred Hosp Prahran Vic Australia 3181 Dis, Prahran, Vic 3181, Australia
Titolo Testata:
JOURNAL OF CLINICAL VIROLOGY
fascicolo: 3, volume: 22, anno: 2001,
pagine: 255 - 261
SICI:
1386-6532(200110)22:3<255:ITRFPV>2.0.ZU;2-V
Fonte:
ISI
Lingua:
ENG
Soggetto:
HUMAN-IMMUNODEFICIENCY-VIRUS; POLYSACCHARIDE VACCINE; PROTECTIVE EFFICACY; HIGH-RISK; CAPSULAR POLYSACCHARIDES; ANTIBODY-RESPONSE; INFECTED PATIENTS; CONTROLLED TRIAL; BACTEREMIA; PNEUMONIA;
Keywords:
HIV; pneumonia; prevention; pneumococcal infections; immunisation; vaccines; Streptococcus pneumoniae;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
26
Recensione:
Indirizzi per estratti:
Indirizzo: Pierce, AB Alfred Hosp, Clin Res Sect, Dept Infect Dis, Commercial Rd, Prahran, Vic 3181, Australia Alfred Hosp Commercial Rd Prahran Vic Australia 3181 Australia
Citazione:
A.B. Pierce e J.F. Hoy, "Is the recommendation for pneumococcal vaccination of HIV patients evidence based?", J CLIN VIRO, 22(3), 2001, pp. 255-261

Abstract

Background: both the current NHMRC guidelines of Australia and the USPHS/IDSA guidelines recommend pneumococcal vaccine be given to all patients withHIV infection despite a paucity of data to support these recommendations. Objectives: the aim of this study was to assess the incidence of invasive pneumococcal disease and use of pneumococcal vaccine in HIV-infected patients at The Alfred Hospital, Melbourne, Australia, and to review the evidence for the current recommendations. Study design: a case record review of all HIV-infected patients followed at The Alfred Hospital diagnosed with pneumonia between 1 June 1996 and 1 June 2000 was performed. Main outcome measures were the incidence of invasive pneumococcal disease and the proportion ofthese individuals who received pneumococcal vaccination. Results: invasivepneumococcal disease was a relatively infrequent event with an incidence of 1.9 per 1000 person years. This rate is lower than the 8.2 per 1000 person years reported for confirmed disease by CDC. Of the 34 patients with either definite invasive, presumptive or possible pneumococcal disease, 16 (47%) had received pneumococcal vaccine, seven of these within 5 years prior tothe episode of pneumonia. In 15 cases, the vaccine was administered when the CD4 cell count was < 500 per mul. Conclusion: lack of efficacy data, rarity of invasive disease plus evidence of infrequent administration delivered predominantly to those who are least likely to benefit, has prompted us to question the value of routinely vaccinating all our HIV-infected patientswith pneumococcal vaccine. Review of the published literature provides conflicting data in support of the current recommendations for administration of pneumococcal vaccine in HIV patients. It may be more cost-effective to concentrate efforts on strategies to improve adherence to ARV therapy, as this has unequivocally been shown to be associated with a reduction in the incidence of pneumococcal disease. (C) 2001 Elsevier Science B.V. All rights reserved.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 29/11/20 alle ore 00:28:10