title: Quantitative and Qualitative Antibody Responses to Immunization With the Pneumococcal Polysaccharide Vaccine in HIV-Infected Patients After Initiation of Antiretroviral Treatment: Results From a Randomized Clinical Trial.
abstract: BACKGROUND
  Pneumococcal vaccination is recommended for human immunodeficiency virus-infected (HIV+) persons; the best timing for immunization with respect to initiation of antiretroviral therapy (ART) is unknown.
  
  
  METHODS
  Double-blind, placebo-controlled trial in HIV+ with CD4(+) T cells/µL (CD4) ≥ 200 randomized to receive the 23-valent pneumococcal polysaccharide vaccine (PPV23) or placebo at enrollment, followed by placebo or PPV23, respectively, 9-12 months later (after ≥6 months of ART). Capsular polysaccharide-specific immunoglobin (Ig) G and IgM levels to serotypes 1, 3, 4, 6B, and 23F, and opsonophagocytic killing activity (OPA) to serotypes 6B and 23F were evaluated 1 month postvaccination.
  
  
  RESULTS
  One hundred seven subjects were enrolled, 72 (67.3%) were evaluable (36/group). Both groups had significant increases in pre- to 1-month postvaccination IgG levels, but negligible to IgM, and significant increases in OPA titers to serotype 6B but not to 23F. There were no significant differences between groups in serotype-specific IgM or IgG levels or OPA titers. For the combined groups, there was a significant correlation between serotype-specific IgG and OPA titers to 23F but not to 6B. There was no correlation between CD4, viral load and IgG responses.
  
  
  CONCLUSIONS
  In HIV+ with CD4 ≥ 200, delaying PPV23 until ≥6 months of ART does not improve responses and may lead to missed opportunities for immunization.
authors.affiliation: Medical Care Line, Infectious Disease Section Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey Veterans Affairs Medical Center Department of Medicine, Baylor College of Medicine.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Rodriguez-Barradas
authors.affiliation: Department of Medicine, Baylor College of Medicine Thomas Street Clinic, Harris Health System, Houston, Texas.
authors.forename: Jose A
authors.initials: JA
authors.lastname: Serpa
authors.affiliation: Department of Pediatrics.
authors.forename: Iona
authors.initials: I
authors.lastname: Munjal
authors.affiliation: Medical Care Line, Infectious Disease Section Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey Veterans Affairs Medical Center Department of Medicine, Baylor College of Medicine.
authors.forename: Daniel
authors.initials: D
authors.lastname: Mendoza
authors.affiliation: Medical Care Line, Infectious Disease Section Department of Medicine, Baylor College of Medicine.
authors.forename: Adriana M
authors.initials: AM
authors.lastname: Rueda
authors.affiliation: Medical Care Line, Infectious Disease Section Department of Medicine, Baylor College of Medicine.
authors.forename: Mahwish
authors.initials: M
authors.lastname: Mushtaq
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Liise-Anne
authors.initials: LA
authors.lastname: Pirofski
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D000907:Antibodies, Bacterial / Q000097:blood*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D008875:Middle Aged; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000276:immunology*; D013296:Streptococcus pneumoniae / Q000276:immunology; D013781:Texas
chemical_list: C414006:23-valent pneumococcal capsular polysaccharide vaccine; D044966:Anti-Retroviral Agents; D000907:Antibodies, Bacterial; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D022242:Pneumococcal Vaccines
keywords: HIV; antibody; antiretroviral treatment; pneumococcal capsular polysaccharides; pneumococcal vaccine