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

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.

Safety profile of the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV)

“…Other studies have also demonstrated that PCV vaccination of HIV-infected children is well tolerated [34]. The higher number of SAEs reported in HIV-infected children than in HIV-exposed children in study 034 was mainly due to a higher incidence of Table 8.…”

“…Infants at higher risk of pneumococcal disease [33,34] were included in two studies of PHiD-CV completed by December 2012. Study 015/016 was an open controlled study conducted in Greece and Spain, in which 137 preterm infants and 149 term infants were enrolled to receive PHiD-CV coadministered with DTPa-HBV-IPV/Hib as primary vaccination at 2-4-6 months of age followed by a booster dose of PHiD-CV co-administered with DTPa-IPV/Hib at 16-18 months [28].…”

Association of time since pneumococcal polysaccharide vaccine receipt and CD4 count with antibody response to the 13-valent pneumococcal conjugate vaccine in HIV-infected adults

“…16 Other studies on earlier pneumococcal conjugate vaccines have also shown that subjects with higher CD4 counts have higher baseline antibody concentrations, and that baseline antibody concentrations strongly correlate with post-vaccination antibody concentrations. 17 This is presumably from a stronger immune response to prior pneumococcal exposure in subjects with higher CD4 counts. This would make sense in that CD4 cells are critical to the creation of germinal centers and the development of longlasting memory B cells, either from pneumococcal natural infection or PCV, that can be boosted though subsequent pneumococcal antigen exposure.…”

Immunization of HIV-infected adult patients — French recommendations

“…34 A review of immunogenicity studies conducted in HIVinfected adults showed that response to conjugated vaccines was improved when vaccination was carried out in patients treated with antiretroviralsindependently of baseline CD4C cell count. 35 Regarding the 13-valent conjugate vaccine, clinical data are lacking. However satisfactory immunogenicity and safety data, including in patients previously vaccinated with the polysaccharide vaccine have been reported.…”