HIV Increases the Risk of Invasive Meningococcemia

Bishoy Faltas, MD

People with HIV infection are at high risk for invasive meningococcal disease. Current guidelines do not recommend vaccination against meningococcal disease for patients with HIV infection, but these patients can choose to be vaccinated.

Patients with HIV infection are at risk for multiple bacterial infections, including those caused by Mycobacterium tuberculosis,Streptococcus pneumoniae, nontyphoid Salmonella,Haemophilus influenzae, and Staphylococcus aureus.1,2 Invasive meningococcal disease is a severe and life-threatening infection. However, data on the risk of meningococcal infection in HIV-positive persons are limited.

A study in the Annals of Internal Medicine explores the relationship between HIV infection and invasive meningococcal disease in New York City.3 The authors matched population-based invasive meningococcal disease surveillance data with HIV and vital statistics registries to calculate rates of invasive meningococcal disease and related deaths from 2000 to 2011 among patients with HIV/AIDS.

The average annual incidence rate of invasive meningococcal disease in patients with HIV/AIDS was 3.4 cases per 100,000 persons. Among HIV-uninfected persons, the rate was 0.34 cases per 100,000 persons-a 10-fold difference.

In NYC, most (87%) invasive meningococcal infections among patients living with HIV and AIDS from 2000 through 2011 were potentially vaccine-preventable. However, the Advisory Committee on Immunization Practices vaccine recommendations for meningococcal disease do not currently include HIV-infected adults as an at-risk group for meningococcal disease.

After the study was completed, an outbreak of invasive meningococcal disease among men who have sex with men occurred in NYC in 2012. Ten of the 17 cases related to that outbreak since January 1, 2012, were in men with HIV/AIDS. Mortality during the outbreak was higher among these men (40%) than in HIV-uninfected persons (29%).

Take-home message

Primary care clinicians should be alert to the high risk and the high morbidity and mortality of invasive meningococcemia in HIV-positive patients. While current guidelines do not recommend vaccination for patients with HIV, patients can choose to be vaccinated.

Cost-effectiveness and vaccine efficacy studies are needed to evaluate the value of national recommendations for routine vaccination.

1. Hart CA, Beeching NJ, Duerden BI, et al. Infections in AIDS. J Med Microbiol. 2000;49:947-967.
2. Huang L, Crothers K. HIV-associated opportunistic pneumonias. Respirology. 2009;14:474-485.

3. Miller L, Arakaki L, Ramautar A, et al. Elevated risk for invasive meningococcal disease among persons with HIV. Ann Intern Med. 2013 Oct 29. doi:10.7326/0003-4819-160-1-201401070-00731