Long-term immune responses and comparative effectiveness of one or two doses of 7-valent pneumococcal conjugate vaccine (PCV7) in HIV-positive adults in the era of combination antiretroviral therapy
Journal
Journal of the International AIDS Society
Journal Volume
19
Journal Issue
1
Pages
20631
Date Issued
2016
Author(s)
Abstract
Introduction: HIV infection impairs maintenance of immunological memory, yet few studies of HIV-positive adults receiving 7-valent pneumococcal conjugate vaccine (PCV7) have followed them beyond the first year. We determined and compared the durability of serological responses and the clinical outcomes of HIV-positive adults annually for five years following vaccination with one or two doses of PCV7. Methods: In this non-randomized clinical trial, 221 pneumococcal vaccine-na?ve HIV-positive adults receiving one (n=109) or two doses four weeks apart (n=112) of PCV7 between 2008 and 2010 were longitudinally followed for evaluation of significant serological response and for episodes of pneumonia and invasive pneumococcal disease. Results: At the time of vaccination, the two groups were well matched for age, risk factors, combination antiretroviral therapy (cART) coverage, CD4 count and plasma HIV RNA load (PVL). At the end of five years, the CD4 counts for the one- and two-dose groups had increased from 407 and 406 to 550 and 592 cells/mL, respectively, and 82.4 and 81.6% of the participants had fully suppressed PVL. Significant immune responses to ?2 serotypes persisted for 67.9 vs 78.6%, 64.2 vs 71.4%, 66.1 vs 71.4%, 57.8 vs 69.6% in the second, third, fourth and fifth years after one and two doses of PCV7 in the intention-to-treat analysis, respectively. In multivariate analysis, immunization with two doses of PCV7 (odds ratio (OR) 1.71, 95% confidence interval (CI) 1.10 to 2.65, p=0.016), concurrent cART (OR 2.16, 95% CI 1.16 to 4.00, p=0.015) and CD4 proliferation (OR 1.12, 95% CI 1.01 to 1.27, p=0.031) were predictive of persistent serological responses in the fifth year. Only one patient in the one-dose group had documented pneumococcal pneumonia (non-bacteraemic) and none had invasive pneumococcal disease in the 6.5 years of follow-up. Conclusions: One or two doses of PCV7 achieve durable seroprotective responses in HIV-treated participants; however, two doses may be more robust than one dose in a larger study population or in real-world populations with less cART coverage. ? 2016 Cheng A et al; licensee International AIDS Society.
SDGs
Other Subjects
Pneumococcus vaccine; virus antibody; virus RNA; anti human immunodeficiency virus agent; bacterium antibody; Pneumococcus vaccine; adult; antibody response; Article; CD4 lymphocyte count; comparative effectiveness; controlled clinical trial; controlled study; drug dose comparison; female; follow up; highly active antiretroviral therapy; human; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; immunogenicity; injection site reaction; intention to treat analysis; male; priority journal; serotype; Streptococcus pneumonia; vaccination; blood; clinical trial; combination drug therapy; comparative study; HIV Infections; immunology; longitudinal study; middle aged; Adult; Anti-HIV Agents; Antibodies, Bacterial; CD4 Lymphocyte Count; Drug Therapy, Combination; Female; Heptavalent Pneumococcal Conjugate Vaccine; HIV Infections; Humans; Longitudinal Studies; Male; Middle Aged; Vaccination
Publisher
International AIDS Society
Type
journal article