Pneumococcal vaccination in HIV-1-infected adults in Uganda: humoral response and two vaccine failures.
OBJECTIVE
To assess the feasibility of establishing a pneumococcal vaccine trial among HIV-1-infected adults in Uganda and to characterize their responses to 23-valent pneumococcal polysaccharide vaccine.


METHODS
An open-label pilot trial to assess recruitment and compliance of HIV-1-infected adults in Uganda to vaccination and to determine the immunogenicity of the vaccine.


METHODS
A community clinic for HIV-1-infected adults in Entebbe, Uganda.


METHODS
Levels of capsule-specific IgG to four common vaccine capsular serotypes were measured before vaccination and 1 month after vaccination. Subsequent rates of disease episodes and deaths, and immunologic responses in two vaccine failures, were followed.


RESULTS
One month after-vaccination, both HIV-1-infected (n = 77) and seronegative control subjects (n = 10) demonstrated a significant rise in capsule-specific immunoglobulin G (IgG) for three of four serotypes tested, but levels were significantly lower among HIV-1-infected patients. In 149 patient-years of follow-up, two (2.6%) developed pneumococcal pneumonia, one bacteremic with serotype 1 and one non-bacteremic with serotype 13, a non-vaccine serotype; both patients showed inadequate killing of the organism in vitro. In this same follow-up period, 29 (38%) patients died.


CONCLUSIONS
HIV-1-infected adults in Uganda are at high risk of pneumococcal disease and show a significant but suboptimal response to pneumococcal vaccine. Although reliable recruitment and follow-up of vaccinees is feasible, evaluation of vaccine efficacy may be compromised by limited responses to common vaccine serotypes, an unknown incidence of disease with non-vaccine serotypes, and a high rate of mortality unrelated to Streptococcus pneumoniae infection.
Medical Research Council Programme on AIDS in Uganda, Uganda Virus Research Institute, Entebbe.
N
N
French
C F
CF
Gilks
A
A
Mujugira
C
C
Fasching
J
J
O'Brien
E N
EN
Janoff
D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control*; D000328:Adult; D000907:Antibodies, Bacterial / Q000096:biosynthesis; D001428:Bacterial Vaccines / Q000276:immunology; D001770:Blood Bactericidal Activity / Q000276:immunology; D005260:Female; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D022242:Pneumococcal Vaccines; D011018:Pneumonia, Pneumococcal / Q000517:prevention & control*; D012852:Sinusitis / Q000150:complications; D013296:Streptococcus pneumoniae / Q000276:immunology*; D014454:Uganda
D000907:Antibodies, Bacterial; D001428:Bacterial Vaccines; D022242:Pneumococcal Vaccines