Risk and Incidence of Pulmonary Diseases among HIV-infected Patients in the Era of Combination Antiretroviral Therapy

From the Authors:

We appreciate the comments by Dr. Hung and colleagues, and their interest in our article (1). We agree that pneumococcal vaccination status is an important factor to consider in assessing the risk for bacterial pneumonia in HIV-infected, as well as HIV-uninfected, persons. Unfortunately, vaccination status was not readily available nationally within the administrative Veterans Affairs (VA) databases at the time that we were conducting analyses for this article. In our prior work analyzing the impact of pneumococcal vaccination status on risk for pneumonia in subjects enrolled in the Veterans Aging Cohort 5 Site Study (VACS 5), we established receipt of pneumococcal vaccine by a combination of retrospective review of VA electronic administrative data and direct medical record review (2). In VACS 5, subjects gave informed consent to permit medical record review; however, direct review of medical records has not been feasible within the 100,260-member Veterans Aging Cohort Study Virtual Cohort (VACS VC), as it has included only administratively available electronic data sources. We have only recently been able to access data within the VA immunization files, and are currently using this data along with a combination of other sources to determine immunization status among subjects in the VACS VC.

We agree that further studies to examine risk factors for bacterial pneumonia among HIV-infected compared with HIV-uninfected patients are warranted, including the impact of vaccination status on risk for bacterial pneumonia. These analyses will also need to consider type and timing of vaccination as well as duration of protection in a series of models with time-varying covariates, expanding substantially beyond the scope of the work presented in our article (1).