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

摘要

Objectives: The objectives of this study were to compare the serologic responses at week 48 to primary vaccination with 23-valent pneumococcal polysaccharide vaccine (PP V) vs. 7-valent pneumococcal conjugate vaccine (PC V); and to identify factors associated with serologic response in HIV-infected adult patients with access to combination antiretroviral therapy (cART). Results: At week 48, patients who received PC V demonstrated a statistically significantly higher response rate to at least 2 serotypes than those who received PP V (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 PC V (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). Methods: One hundred and four CD4-matched pairs of HIV-infected patients who underwent primary pneumococcal vaccination with 23-valent PP V or 7-valent PC V 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. Conclusions: Primary vaccination with 7-valent PC V achieved a significantly better serologic responses to one or two out of the four serotypes studied at week 48 than with 23-valent PP V in HIV-infected patients in the cART era. Suppression of HIV replication when primary vaccination was administered was associated with better serologic responses.