HIV-infected persons and men-who-have-sex-with-men (MSM) have been found to have an increased risk of invasive meningococcal disease (IMD) and several serogroup C IMD outbreaks among HIV-infected and uninfected MSM have been reported since 2001. However, the Advisory Committee on Immunization Practices does not recommend routine meningococcal vaccination for HIV-infected persons or MSM. IMD surveillance data typically do not accurately capture these risk factors; HIV data collection for IMD cases was prohibited by law in California until September 2014 and MSM status was not routinely collected in California until 2013. Our objectives were to determine HIV and MSM status of male IMD cases reported to the California Department of Public Health (CDPH) using the CDPH HIV registry and to evaluate the risk of IMD and fatal IMD among HIV-infected men compared with uninfected men.
METHODS:
IMD cases among men aged 18-65 years reported to CDPH during 2007-2014 were matched with the CDPH HIV registry using a probabilistic matching algorithm based on last name, first name, date of birth and sex. Case report forms and medical records were reviewed to confirm HIV status for IMD cases identified by matching. Descriptive statistics were used to compare HIV-infected and uninfected IMD cases. Risks were calculated using population denominator estimates obtained from the CDPH Office of AIDS and CDPH Department of Finance.
RESULTS:
During 2007-2014, 306 IMD cases among males aged 18-65 years were reported to CDPH; 21 (7%) were determined to be HIV-infected, 18 (86%) of whom were also reported as MSM. The relative risk for IMD among HIV-infected men compared with uninfected men was 8.9 (95% CI, 5.7-13.9). Six (29%) HIV-infected men died compared with 49 (17%) uninfected men and the relative risk of death was significantly higher among HIV-infected men compared with uninfected men (RR 14.8; 95% CI, 6.4-34.6). Of the 16 HIV-infected men with serogroup results, all had vaccine-preventable serogroups; 11 (69%) were C, 4 (25%) B, 1 (6%) Y.
CONCLUSIONS:
The relative risks for IMD and fatal IMD were significantly increased among HIV-infected men compared to uninfected men aged 18-65 years in California. HIV registry data should be reviewed to obtain more accurate data on HIV and MSM status among IMD cases. Our findings provide additional evidence that HIV-infected men are more likely to be infected and die of IMD. Cost-effectiveness and vaccine efficacy studies are warranted for this population to further explore the potential benefit of routine vaccination.