ABSTRACT
A cohort of predominantly HIV seropositive female prostitutes has been followed for a two year period. 54 episodes of invasive pneumococcal disease (ISpD) have been diagnosed in 41 patients; of which 28 were bacteraemic. All patients were seropositive for HIV. Pneumonia was the most common presentation in 34(64); then maxillary sinusitis in 11 (21) and occult bacteraemia in 8 (15). Nine of the patients (22) had proven recurrent disease despite appropriate therapy; most of these episodes were with different serotypes suggesting that this is reinfection rather than relapse. The mean CD4 count of first episode ISpD was 325 showing that that this is an early HIV-related problem. The estimated inicdence rate was 30/1000 person years of observation and it was the most common life-threatening problem seen in the cohort in the study period. All patients survived with standard penicillin or ampicillin treatment. The pneumococcus is an important but under-recognised cause of HIV-related disease in Africa. Presentation can be atypical but the response to appropriate therapy good