title: Serologic response to primary vaccination with 7-valent pneumococcal conjugate vaccine is better than with 23-valent pneumococcal polysaccharide vaccine in HIV-infected patients in the era of combination antiretroviral therapy.
abstract: OBJECTIVE
  The objectives of this study were to compare the serologic responses at week 48 to primary vaccination with 23-valent pneumococcal polysaccharide vaccine (PPV) vs. 7-valent pneumococcal conjugate vaccine (PCV); and to identify factors associated with serologic response in HIV-infected adult patients with access to combination antiretroviral therapy (cART).
  
  
  METHODS
  One hundred and four CD4-matched pairs of HIV-infected patients who underwent primary pneumococcal vaccination with 23-valent PPV or 7-valent PCV were enrolled for determinations of anti-capsular antibody responses against four serotypes (6B, 14, 19F and 23F) at baseline, 24 weeks and 48 weeks following vaccination. Significant antibody responses were defined as 2-fold or greater increase of antibody levels at week 48 compared with baseline. The logistic regression model was used to determine the factors associated with serologic response to at least one and two serotypes.
  
  
  RESULTS
  At week 48, patients who received PCV demonstrated a statistically significantly higher response rate to at least 2 serotypes than those who received PPV (37.5% vs. 20.2%, p = 0.006). In multivariate analysis, factors associated with significant antibody responses to at least one or two serotypes included receipt of PCV (adjusted odds ratio [AOR], 2.42 [95% CI, 1.23-4.78] and 3.58 [95% CI. 1.76-7.28], respectively), and undetectable plasma HIV RNA load (< 400 copies/ml) at vaccination (AOR, 1.47 [95% CI, 0.60-3.64] and 3.62 [95% CI, 1.11-11.81], respectively).
  
  
  CONCLUSIONS
  Primary vaccination with 7-valent PCV achieved a significantly better serologic responses to one or two out of the four serotypes studied at week 48 than with 23-valent PPV in HIV-infected patients in the cART era. Suppression of HIV replication when primary vaccination was administered was associated with better serologic responses.
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: Chien-Ching
authors.initials: CC
authors.lastname: Hung
authors.forename: Yu-Chung
authors.initials: YC
authors.lastname: Chuang
authors.forename: Wen-Chun
authors.initials: WC
authors.lastname: Liu
authors.forename: Chin-Ting
authors.initials: CT
authors.lastname: Su
authors.forename: Yi-Ching
authors.initials: YC
authors.lastname: Su
authors.forename: Shu-Fang
authors.initials: SF
authors.lastname: Chang
authors.forename: Sui-Yuan
authors.initials: SY
authors.lastname: Chang
authors.forename: Shan-Chwen
authors.initials: SC
authors.lastname: Chang
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D000907:Antibodies, Bacterial / Q000097:blood; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D006801:Humans; D008297:Male; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000276:immunology / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage* / Q000276:immunology*; D019562:Viral Load
chemical_list: C414006:23-valent pneumococcal capsular polysaccharide vaccine; D044966:Anti-Retroviral Agents; D000907:Antibodies, Bacterial; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022242:Pneumococcal Vaccines
keywords: HIV infection; Streptococcus pneumoniae; combination antiretroviral therapy; immunogenicity; pneumococcal conjugate vaccine; pneumococcal polysaccharide vaccine