title: Immunization against pneumococcal disease in HIV-infected patients: conjugate versus polysaccharide vaccine before or after reconstitution of the immune system (CTN-147).
abstract: To investigate whether patients should be immunized immediately or delay immunization until after reconstitution of the immune system and whether a conjugate or polysaccharide vaccine results in a better immunologic response. Seventy-nine patients were randomly assigned, utilizing a two by two factorial design to receive immediate immunization or delay immunization. Baseline characteristics were similar for the four arms: 78% men, median age 41 years, median time since HIV diagnosis 0.3 years, median CD4 60 cells/mm(3) and median HIV viral load 5.02 log copies/mL. Results in favour of delayed immunization were observed for those serotypes showing a response. The proportional odds ratios for delayed versus immediate immunization were 0.341 (P = 0.04) and 0.204 (P = 0.004) at months 6 and 12, respectively. No differences in immunological response were observed between the two individual vaccines for the shared serotypes studied. HIV-infected adults produced a higher immunological response to pneumococcal vaccine after reconstitution of the immune system.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Halifax, Nova Scotia, Canada.
authors.forename: K L
authors.initials: KL
authors.lastname: Slayter
authors.forename: J
authors.initials: J
authors.lastname: Singer
authors.forename: T C K
authors.initials: TC
authors.lastname: Lee
authors.forename: H
authors.initials: H
authors.lastname: Kayhty
authors.forename: W F
authors.initials: WF
authors.lastname: Schlech
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000907:Antibodies, Bacterial / Q000276:immunology; D018791:CD4 Lymphocyte Count; D002170:Canada; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000276:immunology* / Q000821:virology; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D006801:Humans; D007114:Immunization; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011008:Pneumococcal Infections / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D013296:Streptococcus pneumoniae / Q000276:immunology*; D013997:Time Factors; D018074:Vaccines, Conjugate / Q000276:immunology*; D019562:Viral Load; D055815:Young Adult
chemical_list: C414006:23-valent pneumococcal capsular polysaccharide vaccine; D000907:Antibodies, Bacterial; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate
keywords: HIV; immune reconstitution; immunogenicity; pneumococcal vaccines