Single-Dose 13-Valent Conjugate Pneumococcal Vaccine in People Living With HIV – Immunological Response and Protection

Abstract

BackgroundPatients living with HIV (PLHIV) are prone to invasive pneumococcal disease. The 13-valent conjugated pneumococcal vaccine (PCV13) is currently recommended for all PLHIV, followed in most guidelines by a 23-valent polysaccharide pneumococcal vaccine. Data are scarce concerning the immunological efficacy of PCV13 among PLHIV.ObjectiveTo assess the immunological response at one month, and the immunological protection at 1-, 6-, and 12 months in PLHIV with a CD4 cell count above 200 cells/µl after a single dose of PCV13, as measured by both ELISA and opsonophagocytic assay (OPA).MethodsPLHIV with CD4 cell count >200 cells/µl were included. Specific IgG serum concentrations for eight serotypes by ELISA and seven serotypes by OPA were measured at baseline, 1-, 6-, and 12 months after the PCV13 vaccination. Global response was defined as a two-fold increase from baseline of specific IgG antibody levels (μg/ml) assayed by ELISA or as a four-fold increase in OPA titer from baseline, for at least five serotypes targeted by PCV13. Global protection was defined as an IgG-concentration ≥1 µg/ml by ELISA or as an opsonization titer ≥LLOQ by OPA for at least five tested serotypes targeted by PCV13. Factors associated with global response and global protection were assessed using logistic regression.ResultsOf the 38 PLHIV included, 57.9% and 63.2% were global responders, 92.1% and 78.9% were globally protected at one month, and 64.7% and 55.9% were still protected at 12 months, by ELISA and OPA respectively. A CD4/CD8 ratio of >0.8 was significantly associated with a better global response by OPA (OR=6.11, p=0.02), and a CD4 nadir <200 was significantly associated with a poorer global response by ELISA (OR=0.22, p=0.04). A CD4 cell count nadir <200 and age over 50 years were associated with poorer global protection by OPA at M1 (OR=0.18, p=0.04) and M12 (OR= 0.15, p=0.02), respectively. Plasma HIV RNA viral load <40 copies/ml was significantly associated with a better global protection at M1 by ELISA and OPA (OR=21.33, p=0.025 and OR=8.40, p=0.04)ConclusionVaccination with PCV13 in these patients induced immunological response and protection at one month. At one year, more than half of patients were still immunologically protected.

Immunological and Clinical Responses to Vaccinations among Adults Living with HIV

“…Smokers (OR = 0.38 CI: 0.22-0.64, p = 0.0004) and those concurrently infected with HCV (OR = 0.25 CI: 0.12-0.54, p = 0.0004) were less likely to respond to vaccination (PCV7, PPV23), according to P. Lesprit et al [48]. Moreover, in a study conducted by J. Romaru et al, a group of HIV-positive patients aged over 50 were less likely (OR = 0.15, CI: 0.03-0.70, p = 0.02) to be globally protected after PCV13 according to OPA results [39]. According to O. Sogaard et al, the addition of CPG 707 adjuvant, a toll-like receptor 9 (TLR9) agonist, increased the proportions of HIV-infected patients developing a high vaccine-specific IgG antibody response to PCV7 (10 months after vaccination (p < 0.001).…”

“…In the studies presented here, the representation of people over 60 years of age is poor, with six of them having no such patients at all [40,44,47,50,52,55]. Moreover, in six of them, it is not distinguished whether this age group participated in the study [39,42,45,48,51,54]. People aged 60 and over were included in five surveys [41,43,46,49,53].…”

“…Current guidelines for HIV-infected patients recommend vaccination with a 15-valent or 20-valent pneumococcal vaccine (PCV15, PCV20), followed by a 23-valent pneumococcal polysaccharide vaccine (PPV23) [38]. A 7-valent and a 13-valent conjugated vaccine (PCV7, PCV13) have also been available in the past, with PPV23 being the subject of most studies on pneumococcal vaccination among HIV-positive patients [39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55].…”

“…According to K. Slayter et al, side effects were more frequently (p < 0.005) reported by patients with a CD4 count below 200 cells/mm 3 (12). The vaccines are considered safe and do not cause a decrease in CD4 count [39][40][41]50].…”

“…According to T. Johannesson et al, isotype-switched memory B cells were a predictor of the 3-, 4-, and 9-month IgG response to PCV7 [46]. J. Romaru et al found that a CD4/CD8 ratio > 0.8 was significantly associated with a better global response by OPA [39].…”