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Observational Study
. 2016 Aug 2;12(8):2117-2123.
doi: 10.1080/21645515.2016.1160987. Epub 2016 May 12.

Association of time since pneumococcal polysaccharide vaccine receipt and CD4 count with antibody response to the 13-valent pneumococcal conjugate vaccine in HIV-infected adults

Alexandria E-B Rossheim  1 , Anna Marie P Young  1 , Julia Siik  1 , Tina D Cunningham  2 , Stephanie B Troy  1
Affiliations
Observational Study

Association of time since pneumococcal polysaccharide vaccine receipt and CD4 count with antibody response to the 13-valent pneumococcal conjugate vaccine in HIV-infected adults

Alexandria E-B Rossheim et al. Hum Vaccin Immunother. .

Abstract

Introduction: Pneumococcal infection is a leading cause of illness and death in HIV-infected adults. Current United States guidelines for HIV-infected adults recommend a single dose of the 13-valent pneumococcal conjugate vaccine (PCV-13) at any CD4 count and at least 1 y after receipt of the 23-valent pneumococcal polysaccharide vaccine (PPV). PPV is known to lead to hyporesponsiveness to subsequent pneumococcal vaccines for at least 1 y Whether PCV-13 would be more immunogenic if administered later after PPV receipt or at higher CD4 counts has not been tested.

Methods: We prospectively collected serum from 96 HIV-infected adults before and after PCV-13 receipt, and measured antibody concentrations against 4 pneumococcal serotypes (3, 6A, 7F, and 19A) via indirect ELISA according to the WHO protocol. Post-booster antibody concentrations and fold-rise in antibody concentrations were compared according to time from PPV receipt and baseline CD4 count using univariate and multivariate analyses.

Results: PPV receipt >3 versus 1-3 y prior did not significantly change post-vaccination antibody concentrations, but was associated with slightly higher fold-rise in antibody concentration for the 3 tested serotypes included in PPV, though this only reached significance for serotype 7F. CD4 count was significantly associated with post-vaccination antibody concentrations for 3 of 4 serotypes, but not for fold-rise in antibody concentration for any serotype.

Conclusion: Waiting longer than 1 y after PPV receipt to administer PCV-13 may slightly improve the antibody response to serotypes included in both vaccines. While higher CD4 count at PCV-13 administration results in higher post-vaccination antibody concentrations, this is likely because higher CD4 count is also associated with higher pre-vaccination antibody concentrations.

Keywords: CD4 Count; HIV; Pneumovax; Prevnar; adults; pneumococcus; vaccine.

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Figures

Figure 1.
Figure 1.
Antibody geometric mean concentrations (GMCs) for each serotype grouped by time since PCV-13 receipt. Bars represent 95% confidence intervals. †One year GMCs are from a different group of subjects (Group 2) than the baseline and one month GMCs (Group 1).
Figure 2.
Figure 2.
The geometric mean of the antibody concentrations at baseline (2A) and 1 month post –vaccination (2B), and the geometric mean of the fold-change in antibody concentrations (2C), according to time since PPV receipt by serotype. Bars represent 95% confidence intervals. There were 42 and 54 subjects in the 1–3 and >3 y since PPV receipt groups respectively. Of note, serotype 6A is included in PCV-13 but not PPV, but serotypes 3, 7F, and 19A are included in both PCV-13 and PPV.
Figure 3.
Figure 3.
The geometric mean of the antibody concentrations at baseline (3A) and one month post –vaccination (3B), and the geometric mean of the fold-change in antibody concentrations (3C), according to CD4 count by serotype. Bars represent 95% confidence intervals. There were 11, 26, 34, and 25 subjects in the<200, 200–499, 500–799, and >800 CD4 cells/mm3 groups respectively.
See this image and copyright information in PMC

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