A Randomized Clinical Trial Comparing Revaccination with Pneumococcal Conjugate Vaccine to Polysaccharide Vaccine among HIV-Infected Adults

• Published in: The Journal of infectious diseases Vol. 202; no. 7; pp. 1114 - 1125
• Main Authors: Crum-Cianflone, Nancy F., Hullsiek, Katherine Huppler, Roediger, Mollie, Ganesan, Anuradha, Patel, Sugat, Landrum, Michael L., Weintrob, Amy, Agan, Brian K., Medina, Sheila, Rahkola, Jeremy, Hale, Braden R., Janoff, Edward N.
• Format: Journal Article
• Language: English
• Published: Oxford The University of Chicago Press 01.10.2010; University of Chicago Press; Oxford University Press
• Subjects: Adolescent; Adult; AIDS; Antibodies; Antibodies, Bacterial - blood; Applied microbiology; Bacteriology; Biological and medical sciences; CD4 Lymphocyte Count; Conjugate vaccines; Female; Fundamental and applied biological sciences. Psychology; Heptavalent Pneumococcal Conjugate Vaccine; Highly active antiretroviral therapy; HIV; HIV Infections - immunology; HIV/AIDS; Human viral diseases; Humans; Immunization, Secondary - methods; Immunoglobulin G - blood; Infectious diseases; Male; Medical sciences; Microbiology; Middle Aged; Miscellaneous; Pneumococcal Infections - prevention & control; Pneumococcal vaccine; Pneumococcal Vaccines - administration & dosage; Pneumococcal Vaccines - immunology; Polysaccharides; RNA; Treatment Outcome; Vaccination; Vaccines, antisera, therapeutical immunoglobulins and monoclonal antibodies (general aspects); Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Young Adult; Infection; Immunopathology; Streptococcaceae; Viral disease; Bacteria; Micrococcales; Clinical trial; AIDS; Vaccine; Immune deficiency; Polysaccharide; Streptococcus pneumoniae
• ISSN: 0022-1899; 1537-6613; 1537-6613
• DOI: 10.1086/656147

Background. The risk of pneumococcal disease persists, and antibody responses to revaccination with the 23-valent polysaccharide vaccine (PPV) are low among human immunodeficiency virus (HIV)-infected adults. We determined whether revaccination with the 7-valent pneumococcal conjugate vaccine (PCV) would enhance these responses. Methods. In a randomized clinical trial, we compared the immunogenicity of revaccination with PCV (n = 131) or PPV (n = 73) among HIV-infected adults (median CD4 cell count, 533 cells/mm3) who had been vaccinated with PPV 3–8 years earlier. HIV-uninfected adults (n = 25) without prior pneumococcal vaccination received 1 dose of PCV. A positive response was defined as a ⩾2-fold increase (from baseline to day 60) in capsule-specific immunoglobulin G, with a postvaccination level ⩾1000 ng/mL for at least 2 of the 4 serotypes. Results. HIV-infected persons demonstrated a higher frequency of positive antibody responses to PCV than to PPV (57% vs 36%) (P = .004) and greater mean changes in the immunoglobulin G concentration frombaseline to day 60 for serotypes 4, 9V, and 19F (P < .05, for all), but not for serotype 14. However, by day 180, both outcomes were similar. Responses to PCV were greater in frequency and magnitude for all serotypes in HIV-uninfected adults, compared with those in HIV-infected adults. Conclusions. Among persons with HIV infection, revaccination with PCV was only transiently more immunogenic than PPV, and responses were inferior to those in HIV-uninfected subjects with primary vaccination. Pneumococcal vaccines with more robust and sustained immunogenicity are needed for HIV-infected adults. Clinical trial registration. ClinicalTrials.gov identifier NCT00622843.