title: Impact of vaccination with seven-valent pneumococcal conjugate vaccine on virologic and immunologic outcomes among HIV-infected adult patients in the era of highly active antiretroviral therapy.
abstract: OBJECTIVE
  Pneumococcal polysaccharide vaccination may be associated with adverse outcomes in HIV-infected individuals who did not receive highly active antiretroviral therapy (HAART). Our aim was to evaluate the impact of vaccination with seven-valent pneumococcal conjugate vaccine (PCV) on the short-term clinical, virologic, and immunologic outcomes among HIV-infected adult patients in the HAART era.
  
  
  METHODS
  A total of 429 HIV-infected adult patients were enrolled from October 2008 to March 2010: 213 received two doses of seven-valent PCV given at a 4-week interval and 216 received one dose. All patients were given 1-week diary to record any discomfort after vaccination. Data of serial CD4 and plasma HIV RNA load measurements were recorded.
  
  
  RESULTS
  Of the 429 patients with a mean CD4 count of 305 cells/μL, 289 (67.4%) were receiving HAART and 175 (40.8%) had plasma HIV RNA load <40 copies/mL at vaccination. Of the 396 patients (92.3%) who returned the diary, injection site soreness (24.0%) and pain (10.4%) were the most commonly reported adverse effects. After 3-4 months of vaccination, CD4 count increased by 40 cells/μL in 278 patients (68.2%) who continued HAART, compared with a decrease of 38 cells/μL in 131 patients (31.8%) who were not on HAART (p < 0.001), while the respective change in plasma HIV RNA load was 0.8 versus 0.2 log(10) copies/mL (p = 0.09). One patient died, two developed opportunistic infections, and one developed pneumococcal pneumonia following vaccination.
  
  
  CONCLUSIONS
  Vaccination with seven-valent PCV among HIV-infected patients is generally safe, which has no detrimental effect on CD4 count and plasma HIV RNA load in patients receiving HAART. (ClinicalTrials.gov number, NCT00885628).
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.
authors.forename: Ching-Lan
authors.initials: CL
authors.lastname: Lu
authors.forename: Sui-Yuan
authors.initials: SY
authors.lastname: Chang
authors.forename: Hsin-Yun
authors.initials: HY
authors.lastname: Sun
authors.forename: Wen-Chun
authors.initials: WC
authors.lastname: Liu
authors.forename: Yu-Tzu
authors.initials: YT
authors.lastname: Tseng
authors.forename: Chia-Ying
authors.initials: CY
authors.lastname: Hsieh
authors.forename: Cheng-Hsin
authors.initials: CH
authors.lastname: Wu
authors.forename: Chien-Ching
authors.initials: CC
authors.lastname: Hung
authors.forename: Shan-Chwen
authors.initials: SC
authors.lastname: Chang
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology / Q000821:virology; D006801:Humans; D007115:Immunization Schedule; D008297:Male; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000009:adverse effects*; D011446:Prospective Studies; D018074:Vaccines, Conjugate / Q000008:administration & dosage / Q000009:adverse effects; D019562:Viral Load
chemical_list: D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate