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J Infect Dis. 2015 Jun 1;211(11):1703-11. doi: 10.1093/infdis/jiu819. Epub 2014 Dec 23.

Quantitative and Qualitative Antibody Responses to Immunization With the Pneumococcal Polysaccharide Vaccine in HIV-Infected Patients After Initiation of Antiretroviral Treatment: Results From a Randomized Clinical Trial.

Author information

1
Medical Care Line, Infectious Disease Section Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey Veterans Affairs Medical Center Department of Medicine, Baylor College of Medicine.
2
Department of Medicine, Baylor College of Medicine Thomas Street Clinic, Harris Health System, Houston, Texas.
3
Department of Pediatrics.
4
Medical Care Line, Infectious Disease Section Department of Medicine, Baylor College of Medicine.
5
Department of Medicine, Division of Infectious Diseases, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York.

Abstract

BACKGROUND:

Pneumococcal vaccination is recommended for human immunodeficiency virus-infected (HIV+) persons; the best timing for immunization with respect to initiation of antiretroviral therapy (ART) is unknown.

METHODS:

Double-blind, placebo-controlled trial in HIV+ with CD4(+) T cells/µL (CD4) ≥ 200 randomized to receive the 23-valent pneumococcal polysaccharide vaccine (PPV23) or placebo at enrollment, followed by placebo or PPV23, respectively, 9-12 months later (after ≥6 months of ART). Capsular polysaccharide-specific immunoglobin (Ig) G and IgM levels to serotypes 1, 3, 4, 6B, and 23F, and opsonophagocytic killing activity (OPA) to serotypes 6B and 23F were evaluated 1 month postvaccination.

RESULTS:

One hundred seven subjects were enrolled, 72 (67.3%) were evaluable (36/group). Both groups had significant increases in pre- to 1-month postvaccination IgG levels, but negligible to IgM, and significant increases in OPA titers to serotype 6B but not to 23F. There were no significant differences between groups in serotype-specific IgM or IgG levels or OPA titers. For the combined groups, there was a significant correlation between serotype-specific IgG and OPA titers to 23F but not to 6B. There was no correlation between CD4, viral load and IgG responses.

CONCLUSIONS:

In HIV+ with CD4 ≥ 200, delaying PPV23 until ≥6 months of ART does not improve responses and may lead to missed opportunities for immunization.

KEYWORDS:

HIV; antibody; antiretroviral treatment; pneumococcal capsular polysaccharides; pneumococcal vaccine

PMID:
25538270
PMCID:
PMC4471434
DOI:
10.1093/infdis/jiu819
[Indexed for MEDLINE]
Free PMC Article

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