Safety, immunogenicity and efficacy of pneumococcal conjugate vaccine in HIV-infected individuals

Hum Vaccin Immunother. 2012 Feb;8(2):161-73. doi: 10.4161/hv.18432. Epub 2012 Feb 1.

Abstract

Streptococcus pneumoniae is the leading bacterial opportunistic infection in HIV-infected individuals. Anti-retroviral treatment (ART) of HIV-infected individuals reduces their risk of invasive pneumococcal disease (IPD), however, it remains 20- to 40-fold greater compared with age-matched general population. This review summarizes the available published data on the immunogenicity, safety and efficacy of pneumococcal polysaccharide-protein conjugate vaccines (PCV) in HIV-infected children and adults. Several studies have demonstrated that PCV are safe in the HIV-infected persons. Although PCV are immunogenic in HIV-infected infants, the antibodies produced are functionally impaired, there is possibly a lack or loss of anamnestic responses and immunity declines in later life However, quantitative and qualitative antibody responses to PCV in HIV-infected infants are enhanced when vaccination occurs whilst on ART, as well as if vaccination occurs when the CD4+ cell percentage is ≥ 25% and if the nadir CD4+ is > 15%. Although the efficacy of PCV was lower, the vaccine preventable burden of hospitalization for IPD and clinical pneumonia were 18-fold and 9-fold greater, respectively, in HIV-infected children compared with -uninfected children. In HIV-infected adults, PCV vaccination induces more durable and functional antibody responses in individuals on ART at the time of vaccination than in ART-naive adults, independently of baseline CD4+ cell count, although there does not appear to be much benefit from a second-dose of PCV. PCV has also been shown to reduce the risk of recurrent IPD by 74% in HIV-infected adults not on ART, albeit, also with subsequent decline in immunity and protection.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • AIDS-Related Opportunistic Infections / drug therapy
  • AIDS-Related Opportunistic Infections / immunology
  • AIDS-Related Opportunistic Infections / prevention & control*
  • Adult
  • CD4 Lymphocyte Count
  • Child
  • HIV / immunology
  • HIV Infections / immunology*
  • Humans
  • Infant
  • Pneumococcal Infections / drug therapy
  • Pneumococcal Infections / immunology
  • Pneumococcal Infections / prevention & control*
  • Pneumococcal Vaccines* / adverse effects
  • Pneumococcal Vaccines* / immunology
  • Streptococcus pneumoniae / immunology
  • Streptococcus pneumoniae / pathogenicity
  • Vaccines, Conjugate* / adverse effects
  • Vaccines, Conjugate* / immunology
  • Vaccines, Conjugate* / therapeutic use

Substances

  • Pneumococcal Vaccines
  • Vaccines, Conjugate