title: Deficient antipneumococcal polysaccharide responses in HIV-seropositive patients.
abstract: In a prospective study, serological responses and opsonic activity towards Streptococcus pneumoniae were measured in 60 HIV-infected patients and 25 controls after the administration of the 23-valent pneumococcal vaccine (PneumovaxR). Serum samples were collected before vaccination and at weeks 1, 2, 4, and 12 after vaccination and were tested for the presence of antibodies against a mixture of capsular polysaccharide antigens (pool) and against type 3 and type 4 antigens (PS3 and PS4), using an ELISA. A serological response was defined as a two-fold or greater increase in serum titer after vaccination. Opsonophagocytosis was measured in patients with a definite response against PS3. Generally, prevaccination antipneumococcal antibody titers were clearly higher in HIV-infected patients than in healthy controls. After vaccination, antipool antibody responses were found in 76% of vaccinated patients; 24% of the patients were non-responders. In patients with more than 0.300 x 10(9) CD4 + cells per liter the percentage of responders was 94%; in patients with fewer than 0.300 x 10(9) CD4 + cells per liter this percentage was 68% (P < 0.05). The antipool response in control subjects was 92%. A serological response to PS3 and PS4 was found in 29% and 49% of the patients, respectively, and was correlated with CD4 + cell count. In controls, these percentages were 48% and 92%, respectively. In 30% of responding patients, antibody titers dropped already to prevaccination levels by week 12 after vaccination. Opsonophagocytosis was not significantly improved by vaccination, probably because of a relatively high preexisting opsonic activity. Although prevaccination conditions may have had an important influence on the study outcome, the results are not in favor of a significant beneficial effect of vaccination with PneumovaxR on antibody formation in HIV-infected patients. This raises further questions as to the relevance of pneumococcal vaccination in this population.
authors.affiliation: University Hospital Utrecht, Department of Internal Medicine, The Netherlands.
authors.forename: A E
authors.initials: AE
authors.lastname: Loeliger
authors.forename: G T
authors.initials: GT
authors.lastname: Rijkers
authors.forename: P
authors.initials: P
authors.lastname: Aerts
authors.forename: A
authors.initials: A
authors.lastname: Been-Tiktak
authors.forename: A I
authors.initials: AI
authors.lastname: Hoepelman
authors.forename: H
authors.initials: H
authors.lastname: van Dijk
authors.forename: J C
authors.initials: JC
authors.lastname: Borleffs
mesh_terms: D000907:Antibodies, Bacterial / Q000096:biosynthesis* / Q000097:blood / Q000276:immunology*; D000942:Antigens, Bacterial / Q000276:immunology; D006679:HIV Seropositivity / Q000097:blood / Q000276:immunology*; D006801:Humans; D009895:Opsonin Proteins; D010587:Phagocytosis / Q000276:immunology; D011135:Polysaccharides, Bacterial / Q000008:administration & dosage / Q000276:immunology*; D011446:Prospective Studies; D013296:Streptococcus pneumoniae / Q000276:immunology*
chemical_list: D000907:Antibodies, Bacterial; D000942:Antigens, Bacterial; D009895:Opsonin Proteins; D011135:Polysaccharides, Bacterial