Abstract
The aim of this study was to compare the immunologic response to a prime-boost immunization strategy combining the 13-valent conjugate pneumococcal vaccine (PCV13) with the 23-valent polysaccharide pneumococcal vaccine (PPSV23) versus the PPSV23 alone in HIV-infected adults. HIV-infected adults were randomized to receive PCV13 at week 0 followed by PPSV23 at week 4 (n = 31, prime-boost group) or PPSV23 alone at week 4 (n = 33, PPSV23-alone group). Serotype specific IgG geometric mean concentration (GMC) and functional oposonophagocytic (OPA) geometric mean titer (GMT) were compared for 12 pneumococcal serotypes shared by both vaccines at week 8 and week 28. The prime-boost vaccine group were more likely to achieve a ≥2-fold increase in IgG GMC and a GMC >1 ug/ml at week 8 (odds ratio (OR) 2.00, 95% confidence interval (CI) 1.46–2.74, p < 0.01) and week 28 (OR 1.95, 95% CI 1.40–2.70, p < 0.01). Similarly, the prime-boost vaccine group were more likely to achieve a ≥4-fold increase in GMT at week 8 (OR 1.71, 95% CI 1.22–2.39, p < 0.01) and week 28 (OR 1.6, 95% CI 1.15–2.3, p < 0.01). This study adds to evidence supporting current pneumococcal vaccination recommendations combining the conjugate and polysaccharide pneumococcal vaccines in the United States and Europe for HIV-infected individuals.
Highlights
Invasive pneumococcal diseases (IPD) remains a significant cause of morbidity and mortality in HIV-infected individuals in the era of highly active antiretroviral therapy (HAART)[1] (Harboe et al 2014b)
In the prime-boost group two patients did not return within the time allocation to receive 23-valent pneumococcal polysaccharide vaccine (PPSV23), one patient withdrew consent and one patient was noted to have received PPSV23 prior to study entry and all were excluded from further analysis
Of participants remaining in the prime-boost group, one patient did not attend for study bloods at week 8 and one patient did not attend for study bloods at week
Summary
Invasive pneumococcal diseases (IPD) remains a significant cause of morbidity and mortality in HIV-infected individuals in the era of highly active antiretroviral therapy (HAART)[1] (Harboe et al 2014b). The incidence of IPD in HIV-infected individuals has been reported at up to 100 times greater than that of the general population[2,3]. Numerous studies have reported a decrease in incidence of IPD following the introduction of HAART, likely due to resultant immune-reconstitution[6,7]. This has not been a consistent finding[8,9,10]. PPSV23 has been shown to be safe and effective for the prevention of pneumococcal infection in the general adult population[11] and covers the majority of pneumococcal serotypes implicated in IPD12,13. Immunogenicity studies with PCV, or combination regimens of PCV7 and PPSV23 conducted in HIV-infected adults have yielded variable results[22,23,24,25,26,27,28,29]
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