Immunological efficacy of a prime-boost pneumococcal vaccination in HIV-infected adults.
OBJECTIVE
To evaluate whether a strategy combining a prime with a 7-valent conjugate pneumococcal vaccine (PCV) followed by a boost with the 23-valent polysaccharide vaccine (PPV) would improve immunogenicity against Streptococcus pneumoniae polysaccharides in HIV-infected patients.


METHODS
Randomized controlled phase II trial.


METHODS
Two-hundred and twelve patients with CD4 cell counts of 200-500 cells/mul and HIV RNA< 4 log10 copies/ml, regardless of antiretroviral treatment, were randomized to receive either PCV at week 0 and PPV at week 4 (n = 106) or PPV alone at week 4 (n = 106). The proportion of responders to 0, 1-2, 3-4, 5-7 serotypes shared by the two vaccines was evaluated at week 8 and compared using a proportional odds model allowing for adjustment for CD4 cell count, HIV RNA and antiretroviral treatment.


RESULTS
At week 8, the profile of response was better in the prime-boost group compared to the PPV group, as determined by the frequency of patients who reached both a twofold increase of serotype-specific IgG levels and IgG level >/= 1 mug/ml [proportional odds ratio (OR), 2.09; 95% confidence interval (CI), 1.25-3.51; P = 0.005]. No differences in responders were found 4 weeks after PCV or PPV alone, suggesting that PCV primed for response to PPV. Early differences between groups remained significant at week 24 (proportional OR, 2.14; 95% CI, 1.30-3.54; P = 0.003).


CONCLUSIONS
In a setting of practical care, a PCV prime-PPV boost strategy enhances the frequency, breadth and magnitude of antibody responses against SPP in HIV-infected adults.
Lesprit
Philippe
P
Henri Mondor Hospital, Créteil, France bINSERM U593, Bordeaux, France.
Pédrono
Gaëlle
G
Molina
Jean-Michel
JM
Goujard
Cécile
C
Girard
Pierre-Marie
PM
Sarrazin
Nathalie
N
Katlama
Christine
C
Yéni
Patrick
P
Morineau
Pascale
P
Delfraissy
Jean-François
JF
Chêne
Geneviève
G
Lévy
Yves
Y
D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control; D000328:Adult; D000907:Antibodies, Bacterial / Q000096:biosynthesis*; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000276:immunology*; D015497:HIV-1; D006801:Humans; D007074:Immunoglobulin G / Q000096:biosynthesis; D008297:Male; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000276:immunology*; D013296:Streptococcus pneumoniae / Q000276:immunology*; D018074:Vaccines, Conjugate / Q000276:immunology
D000907:Antibodies, Bacterial; D007074:Immunoglobulin G; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate