Elevated risk for invasive meningococcal disease among persons with HIV.

BACKGROUND: An association between HIV and invasive meningococcal disease (IMD) has been suggested by several previous studies but has not been fully described in the era of highly active antiretroviral therapy in the United States.

OBJECTIVE: To estimate the risk for IMD and death in people living with HIV/AIDS (PLWHA) in New York City (NYC) and the contribution of CD4(+) cell count and viral load (VL) to IMD risk.

DESIGN: Comparison of the incidence rate of IMD among PLWHA with that among HIV-uninfected persons. Surveillance data on IMD for patients aged 15 to 64 years from 2000 to 2011 were matched to death and HIV registries to calculate IMD risk and case-fatality ratios. A subset of PLWHA who had a CD4(+) cell count and VL measurement near the time of their IMD infection was included in age-matched case-control analyses to assess HIV markers and IMD risk.

SETTING: Retrospective cohort from communicable disease surveillance.

PATIENTS: 265 persons aged 15 to 64 years with IMD during 2000 to 2011.

MEASUREMENTS: Meningococcal and HIV data abstracted from surveillance and registry databases, including CD4(+) cell counts and VL.

RESULTS: The average annual incidence rate of IMD was 0.39 cases per 100 000 persons. The relative risk for IMD among PLWHA in NYC during 2000 to 2011 was 10.0 (95% CI, 7.2 to 14.1). Among PLWHA, patients with IMD were 5.3 times (CI, 1.4 to 20.4 times) as likely as age-matched control patients to have CD4(+) counts less than 0.200 × 10(9) cells/L.

LIMITATION: Missing data on smoking status and comorbidity.

CONCLUSION: People living with HIV/AIDS in NYC are at increased risk for IMD. Cost-effectiveness and vaccine efficacy studies are needed to evaluate the value of a national recommendation for routine meningococcal vaccination of PLWHA.

PRIMARY FUNDING SOURCE: New York City Tax Levy.