Pneumococcal vaccination among HIV-infected adult patients in the era of combination antiretroviral therapy

Lee, Kuan-Yeh; Tsai, Mao‐Song; Kuo, Kuang-Che; Tsai, Jen-Chih; Sun, Hsin‐Yun; Cheng, Aristine; Chang, Sui‐Yuan; Lee, Chen‐Hsiang; Hung, Chien‐Ching

doi:10.4161/hv.32247

Cited by 33 publications

(27 citation statements)

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“…Of older (aged 2 to 18 years) HIV-positive children who received two doses of PCV7 plus one dose of PPV23, 82% had persistent immune responses (≥0.5 µg/mL) at five years against serotypes 6B and 14 [53]. Of our cohort, 68 to 100% had persistent immune responses (using the threshold of 1 µg/mL adopted for adults as a measure of seroprotection [9,57]) at five years against serotypes 6B, 14, 19F and 23F. The percentage of persistent responders (≥1 µg/mL) to the two vaccine serotypes with generally the lowest responses (6B and 23F) for rheumatoid participants after one dose at 1.5 years was remarkably lower (21%) than our one-dose HIV-positive vaccinees (72%) at two years [51].…”

Section: Discussionmentioning

confidence: 99%

“…Of our cohort, 68 to 100% had persistent Table 2. Percentage of HIV-positive adults with persistent immune responses defined by a twofold or more IgG rise to at least two Streptococcus pneumoniae serotypes in the second, third, fourth and fifth years following one or two doses of PCV7 by intention-to-treat (ITT) and per-protocol (PP) analyses (primary end point) immune responses (using the threshold of 1 mg/mL adopted for adults as a measure of seroprotection [9,57]) at five years against serotypes 6B, 14, 19F and 23F. The percentage of persistent responders ( ]1 mg/mL) to the two vaccine serotypes with generally the lowest responses (6B and 23F) for rheumatoid participants after one dose at 1.5 years was remarkably lower (21%) than our one-dose HIV-positive vaccinees (72%) at two years [51].…”

Section: Discussionmentioning

confidence: 99%

“…This risk may be related to HIV-related accelerated senescence of immune repertoire and loss of memory B cells prior to viral suppression and the relative dysregulation of the reconstituted but incompletely restored immune system following antiretroviral therapy [4–8]. Consequently most authorities, including the Advisory Committee on Immunization Practices of the US Centers for Disease Control and Prevention, the World Health Organization (WHO), the European AIDS Clinical Society and the British HIV Association, recommend pneumococcal vaccination for all HIV-positive adults regardless of immune status [9–13]. …”

Section: Introductionmentioning

confidence: 99%

“…The 23-valent PPV may be administered subsequently to broaden serotype coverage [16]. Given the improved survival of HIV-positive persons on cART, when and how many doses should be administered as revaccination over the lifetime of HIV-positive persons following priming with vaccination with PCVs become important clinical issues [9]. …”

Section: Introductionmentioning

confidence: 99%

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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

Cheng

Chang

Tsai

et al. 2016

Journal of the International AIDS Society

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IntroductionHIV 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.MethodsIn this non-randomized clinical trial, 221 pneumococcal vaccine-naïve 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.ResultsAt 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/µL, 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.ConclusionsOne 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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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

Cheng

Chang

Tsai

et al. 2016

Journal of the International AIDS Society

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“…Recent studies focus on B cell memory and immunological response post immunizations, though most constitute solely cross-sectional studies[8-12,14]. …”

Section: Discussionmentioning

confidence: 99%

Antiretroviral naive and treated patients: Discrepancies of B cell subsets during the natural course of human immunodeficiency virus type 1 infection

Tsachouridou

Skoura

Zebekakis

et al. 2016

WJV

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AIMTo evaluate alterations of memory B cell subpopulations during a 48-wk period in human immunodeficiency virus type 1 (HIV-1) patients.METHODSForty-one antiretroviral naïve and 41 treated HIV-1 patients matched for age and duration of HIV infection were recruited. All clinical, epidemiological and laboratory data were recorded or measured. The different B cell subsets were characterized according to their surface markers: Total B cells (CD19+), memory B cells (CD19+CD27+, BMCs), resting BMCs (CD19+CD27+CD21high, RM), exhausted BMCs (CD19+CD21lowCD27-, EM), IgM memory B (CD19+CD27+IgMhigh), isotype-switched BMCs (CD19+CD27+IgM-, ITS) and activated BMCs (CD19+CD21low+CD27+, AM) at baseline on week 4 and week 48.RESULTSMean counts of BMCs were higher in treated patients. There was a marginal upward trend of IgM memory B cell proportions which differed significantly in the treated group (overall trend, P = 0.004). ITS BMC increased over time significantly in all patients. Naive patients had of lower levels of EM B cells compared to treated, with a downward trend, irrespectively of highly active antiretroviral therapy (HAART) intake. Severe impairment of EM B cells was recorded to both treated (P = 0.024) and naive (P = 0.023) and patients. Higher proportions of RM cells were noted in HAART group, which differed significantly on week 4th (P = 0.017) and 48th (P = 0.03). Higher levels of AM were preserved in HAART naive group during the whole study period (week 4: P = 0.018 and 48: P = 0.035). HIV-RNA viremia strongly correlated with AM B cells (r = 0.54, P = 0.01) and moderately with RM cells (r = -0.45, P = 0.026) at baseline.CONCLUSIONHIV disrupts memory B cell subpopulations leading to impaired immunologic memory over time. BMC, RM, EM and ITS BMC were higher in patients under HAART. Activated BMCs (AM) were higher in patients without HAART. Viremia correlated with AM and RM. Significant depletion was recorded in EM B cells irrespectively of HAART intake. Perturbations in BMC-populations are not fully restored by antiretrovirals.

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HIV infection and the implication for COVID‐19 vaccination

Oyelade

Raya

Latief

2022

Public Health Challenges

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Human immunodeficiency virus (HIV) is associated with altered cellular and humoral immune response, especially in patients with an untreated or chronic infection. This may be due to direct and/or indirect HIV viral activities resulting in T‐ and B‐cells dysfunctions. Although still unclear, various studies have proposed that HIV infection may exacerbate the clinical outcomes of COVID‐19. Indeed, COVID‐19 vaccines were developed in record time and have been shown to reduce the severity of COVID‐19 in the general population. These vaccines were also earmarked as a solution to global disruptions caused by the COVID‐19 pandemic. HIV infection has been reported to reduce the efficacy of various other vaccines including those used against Streptococcus pneumoniae, Clostridium tetani, and influenza viruses. However, current guidelines for the administration of available COVID‐19 vaccines do not account for the immune‐compromised state of people living with HIV (PLWH). We discuss here the potentials, nature, and implications of this HIV‐induced dampening of the humoral immune response on COVID‐19 vaccines by first reviewing the literature about efficacy of previous vaccines in PLWH, and then assessing the proportion of PLWH included in phase III clinical trials of the COVID‐19 vaccines currently available. The clinical and public health implications as well as suggestions for governments and non‐governmental organizations are also proposed in the context of whether findings on the safety and efficacy of the vaccines could be extended to PLWH. Impacts The human immunodeficiency virus (HIV) is characterized by attenuated humoral immunity that may reduce the efficacy of vaccines in people living with HIV (PLWH). Vaccination against the SARS‐CoV‐2 infection remains the main public health answer to the COVID‐19 pandemic. Although no significant safety concerns have been raised regarding the COVID‐19 vaccines in PLWH, the efficacy of these vaccines in PLWH has not received due attention. Indeed, phase III clinical trials for the safety and efficacy of COVID‐19 vaccines involved a significantly low number of PLWH. There are major gaps in knowledge on the efficacy of COVID‐19 vaccines in PLWH and until further research is carried out, PLWH should be prioritized along with other at‐risk groups for repeated vaccination and safeguard.

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Pneumococcal vaccination among HIV-infected adult patients in the era of combination antiretroviral therapy

Cited by 33 publications

References 68 publications

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

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

Antiretroviral naive and treated patients: Discrepancies of B cell subsets during the natural course of human immunodeficiency virus type 1 infection

HIV infection and the implication for COVID‐19 vaccination

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