Journal of Infectious Diseases
Volume 212 Issue 1 July 1, 2015
http://jid.oxfordjournals.org/content/curren

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Editorial Commentaries
Stimulating Evidence for Pneumococcal Conjugate Vaccination Among HIV-Infected Adults
Nancy F. Crum-Cianflone1,2 and Mark R. Wallace3
Author Affiliations
1Infectious Disease Physician, Scripps Mercy Hospital
2Infectious Disease Division, Naval Medical Center San Diego, California
3Infectious Disease Physician, Skagit Valley Hospital, Mt Vernon, Washington
(See the major article by Glesby et al on pages 18–27.)
[Extract]
Streptococcus pneumoniae remains a formidable foe—it is the leading cause of bacterial pneumonia and an important cause of invasive disease. Adults infected with human immunodeficiency virus (HIV) are at particular risk for invasive pneumococcal disease (IPD), with an approximate 40-fold risk compared with the general population despite the advent of combination antiretroviral therapy (cART) [1–3]. Furthermore, up to 25% of HIV-infected persons develop recurrent disease, most commonly because of reinfection [4, 5]. The annual IPD incidence of 245 cases per 100 000 among HIV-positive adults in the developed world [2] points to the need for additional modalities to prevent this all too common infection.

The burden of pneumococcal disease among adults infected with HIV may be mitigated by several strategies including the use of effective cART, the avoidance of specific modifiable behaviors (eg, smoking, illicit drug use), prophylaxis against Pneumocystis carinii pneumonia (ie, trimethoprim-sulfamethoxazole), and annual influenza vaccination [1, 6, 7]. The most specific intervention to reduce IPD is the use of pneumococcal vaccination [6]. Two types of pneumococcal vaccines currently exist—a pneumococcal polysaccharide vaccine containing 23 serotypes (PPSV23) available since 1983, and pneumococcal conjugate vaccines (PCVs), available since 2000 as a 7-valent (PCV7) and since 2010 as a 13-valent (PCV13) formulation.

Given the risk of IPD among HIV-infected persons, vaccine advisory committees have recommended pneumococcal vaccinations since the 1980s [8]. Initially, guidelines advised a single dose of PPSV23 at HIV diagnosis, followed by revaccination at 5 years and then again at age 65 years (assuming ≥5 years had elapsed since last vaccine). Unfortunately, after PPSV23 anti-pneumococcal antibody levels rapidly decline [9], leaving HIV-infected patients at continued substantial risk for …

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Immunogenicity and Safety of 13-Valent Pneumococcal Conjugate Vaccine in HIV-Infected Adults Previously Vaccinated With Pneumococcal Polysaccharide Vaccine
Marshall J. Glesby1, Wendy Watson3, Cynthia Brinson4, Richard N. Greenberg5, Jacob P. alezari6, Daniel Skiest7, Vani Sundaraiyer8, Robert Natuk2, Alejandra Gurtman2, Daniel A. Scott2, Emilio A. Emini2, William C. Gruber2 and Beate Schmoele-Thoma9
Author Affiliations
1Weill Cornell Medical College, New York, New York
2Pfizer Inc, Pearl River, New York
3Pfizer Inc, Collegeville, Pennsylvania
4Central Texas Clinical Research, Austin
5University of Kentucky Medical Center, Lexington
6Quest Clinical Research, San Francisco, California
7Baystate Medical Center, Springfield, Massachusetts
8inVentiv Health Clinical, Princeton, New Jersey
9Pfizer GmbH, Berlin, Germany
Presented in part: 20th Conference on Retroviruses and Opportunistic Infections, Atlanta, Georgia, March 2013.
Abstract
Background.
Persons with human immunodeficiency virus (HIV) infection are at increased risk of pneumococcal disease. We evaluated the safety and immunogenicity of 13-valent pneumococcal conjugate vaccine (PCV13) in this population.
Methods.
HIV-infected persons ≥18 years of age who were previously vaccinated with ≥1 dose of 23-valent pneumococcal polysaccharide vaccine (PPSV23) and had CD4 cell counts ≥200 cells/mm3 and HIV viral loads <50 000 copies/mL were enrolled in this 3-dose PCV13 open-label study.
Results.
A total of 329 subjects received ≥1 dose, and 279 received 3 doses administered at 6-month intervals. Increases in anticapsular polysaccharide immunoglobulin G concentrations and opsonophagocytic antibody titers were demonstrated 1 month after each of the 3 doses of PCV13. Antibody levels were generally similar after each dose. The responses were similar whether subjects had previously received 1 or ≥2 doses of PPSV23. Pain at the injection-site was the most common local reaction. Severe injection site or systemic events were uncommon.
Conclusions.
Vaccination with PCV13 induces anticapsular immunoglobulin G and opsonophagocytic antibody responses in HIV-infected adults with prior PPSV23 vaccination and CD4 cell counts ≥200 cells/mm3. The observations support the use of PCV13 in this population.
Clinical Trials Registration. NCT00963235.