Open AccessLong‐term immune responses and comparative effectiveness of one or two doses of 7‐valent pneumococcal conjugate vaccine (PCV7) in HIV‐positive adults in the era of combination antiretroviral therapy
Author(s) -
Cheng Aristine,
Chang SuiYuan,
Tsai MaoSong,
Su YiChing,
Liu WenChun,
Sun HsinYun,
Hung ChienChing
Publication year - 2016
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.7448/ias.19.1.20631
Subject(s) - medicine , pneumococcal conjugate vaccine , pneumococcal pneumonia , vaccination , serology , viral load , immunology , confidence interval , odds ratio , cart , pneumococcal vaccine , streptococcus pneumoniae , human immunodeficiency virus (hiv) , antibody , antibiotics , microbiology and biotechnology , biology , mechanical engineering , engineering
HIV infection impairs maintenance of immunological memory, yet few studies of HIV‐positive adults receiving 7‐valent pneumococcal conjugate vaccine (PCV7) have followed them beyond the first year. We determined and compared the durability of serological responses and the clinical outcomes of HIV‐positive adults annually for five years following vaccination with one or two doses of PCV7. Methods In this non‐randomized clinical trial, 221 pneumococcal vaccine‐naïve HIV‐positive adults receiving one ( n =109) or two doses four weeks apart ( n =112) of PCV7 between 2008 and 2010 were longitudinally followed for evaluation of significant serological response and for episodes of pneumonia and invasive pneumococcal disease. Results At the time of vaccination, the two groups were well matched for age, risk factors, combination antiretroviral therapy (cART) coverage, CD4 count and plasma HIV RNA load (PVL). At the end of five years, the CD4 counts for the one‐ and two‐dose groups had increased from 407 and 406 to 550 and 592 cells/µL, respectively, and 82.4 and 81.6% of the participants had fully suppressed PVL. Significant immune responses to ≥2 serotypes persisted for 67.9 vs 78.6%, 64.2 vs 71.4%, 66.1 vs 71.4%, 57.8 vs 69.6% in the second, third, fourth and fifth years after one and two doses of PCV7 in the intention‐to‐treat analysis, respectively. In multivariate analysis, immunization with two doses of PCV7 (odds ratio (OR) 1.71, 95% confidence interval (CI) 1.10 to 2.65, p =0.016), concurrent cART (OR 2.16, 95% CI 1.16 to 4.00, p =0.015) and CD4 proliferation (OR 1.12, 95% CI 1.01 to 1.27, p =0.031) were predictive of persistent serological responses in the fifth year. Only one patient in the one‐dose group had documented pneumococcal pneumonia (non‐bacteraemic) and none had invasive pneumococcal disease in the 6.5 years of follow‐up. Conclusions One or two doses of PCV7 achieve durable seroprotective responses in HIV‐treated participants; however, two doses may be more robust than one dose in a larger study population or in real‐world populations with less cART coverage.