Incidence, Clinical Features and Vaccination Coverage of Pneumococcal Disease in People Living with HIV: A Retrospective Cohort Study (2015–2024)

<b>Introduction:</b> The incidence of pneumococcal disease (PD) in people living with HIV (PLWH) is higher than in the general population; therefore, this study aimed to analyze its incidence, clinical characteristics and vaccination coverage in PLWH. <b>Methods:</b> We conducted a retrospective, single-center study between 2015 and 2024 in Hospital Clínic, Barcelona, involving HIV patients who presented with PD during the study period (any patient with a microbiologically confirmed result). A descriptive analysis of cases was carried out and compared with patients who did not present PD during the study period. <b>Results:</b> A total of 177 episodes of PD were identified in 148 individuals, with a cumulative incidence of 1.7% (95% CI: 1.4-2.0). The median age at PD diagnosis was 45.9 (36-53) years; 64% of patients were Spanish-born; 50% of patients were men who have sex with men (MSM); the HIV transmission mode was intravenous drug use in 28% of cases; the median CD4 nadir was 181 (58-324) cells/mm³; the median CD4 prior to PD was 429 (240-663) cells/mm³; and the median peak HIV viral load (VL) was 176,839 (20,900-502,000) copies/mL. Intravenous drug use (OR 3.43; 95% CI 2.19-5.36; <i>p</i> < 0.001), peak HIV VL (OR 1.11; 95% CI 1.02-1.21; <i>p</i> = 0.011), and CD4 nadir (OR 0.92; 95% CI 0.87-0.98; <i>p</i> = 0.005) were independently associated with PD, and fifty-one percent of patients had not received any vaccination prior to their PD episode. <b>Conclusion:</b> PD incidence was high in our study and associated with poor immunological status. Research on new strategies to improve vaccination coverage and immunogenicity in PLWH is needed.