title: 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.
authors.affiliation: Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases & Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Marta C
authors.initials: MC
authors.lastname: Nunes
authors.forename: Shabir A
authors.initials: SA
authors.lastname: Madhi
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000276:immunology / Q000517:prevention & control*; D000328:Adult; D018791:CD4 Lymphocyte Count; D002648:Child; D006678:HIV / Q000276:immunology; D015658:HIV Infections / Q000276:immunology*; D006801:Humans; D007223:Infant; D011008:Pneumococcal Infections / Q000188:drug therapy / Q000276:immunology / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000009:adverse effects / Q000276:immunology; D013296:Streptococcus pneumoniae / Q000276:immunology / Q000472:pathogenicity; D018074:Vaccines, Conjugate / Q000009:adverse effects / Q000276:immunology / Q000627:therapeutic use
chemical_list: D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate