Evaluation of Effectiveness of the 23-Valent Pneumococcal Capsular Polysaccharide Vaccine for HIV-Infected Patients

Breiman, Robert F.; Keller, David W.; Phelan, Maureen; Sniadack, David H.; Stephens, David S.; Rimland, David; Farley, Monica M.; Schuchat, Anne; Reingold, Arthur

doi:10.1001/archinte.160.17.2633

Cited by 161 publications

(90 citation statements)

References 27 publications

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“…Similarly, contact with a child has been recognized as a risk for IPD in HIV-infected adults [23]. The fraction of IPD in adults owing to serotypes recognized as 'paediatric' types because their natural habitat is the nasopharynx of healthy children, such as those belonging to serogroups 6, 9, 19 and 23, as well as serotype 14, increases as a cause of IPD with increasing age such that these strains caused more than 50 per cent of IPD in over 85 year olds in the USA prior to introduction of PCV7 [24].…”

Section: Children Play a Significant Role In Pneumococcal Disease Tramentioning

confidence: 99%

Contribution of vaccines to our understanding of pneumococcal disease

Klugman

2011

Phil. Trans. R. Soc. B

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Pneumonia is the leading cause of mortality in children in developing countries and is also the leading infectious cause of death in adults. The most important cause of pneumonia is the Gram-positive bacterial pathogen, Streptococcus pneumoniae, also known as the pneumococcus. It has thus become the leading vaccine-preventable cause of death and is a successful and diverse human pathogen. The development of conjugate pneumococcal vaccines has made possible the prevention of pneumococcal disease in infants, but has also elucidated aspects of pneumococcal biology in a number of ways. Use of the vaccine as a probe has increased our understanding of the burden of pneumococcal disease in children globally. Vaccination has also elucidated the clinical spectrum of vaccine-preventable pneumococcal infections; the identification of a biological niche for multiple pneumococcal serotypes in carriage and the differential invasiveness of pneumococcal serotypes; the impact of pneumococcal transmission among children on disease burden in adults; the role of carriage as a precursor to pneumonia; the plasticity of a naturally transformable pathogen to respond to selective pressure through capsular switching and the accumulation of antibioticresistance determinants; and the role of pneumococcal infections in hospitalization and mortality associated with respiratory viral infections, including both seasonal and pandemic influenza. Finally, there has been a recent demonstration that pneumococcal pneumonia in children may be an important cause of hospitalization for those with underlying tuberculosis.

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Section: Children Play a Significant Role In Pneumococcal Disease Tramentioning

confidence: 99%

Contribution of vaccines to our understanding of pneumococcal disease

Klugman

2011

Phil. Trans. R. Soc. B

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“…The finding of a detrimental effect of PPV-23 in a randomized trial further fuelled the debate on the effectiveness of the vaccine [14]. Based on observational studies [6,[15][16][17][18][19] and expert opinion, current US guidelines recommend immunization of patients with PPV-23 when CD4 counts are above 200 cells/mL [20], whereas the World Health Organization (WHO) states that the pneumococcal polysaccharide vaccine may be considered for people with HIV infection in WHO clinical stage 1 or, if CD4 testing is available, with a CD4 count above 500 cells/mL [21]. However, study quality and the risk of bias in these studies have not been assessed.…”

Section: Introductionmentioning

confidence: 99%

The effectiveness of pneumococcal polysaccharide vaccination in HIV-infected adults: a systematic review

et al. 2010

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ObjectiveThe effectiveness of 23-valent pneumococcal polysaccharide vaccine (PPV-23) in preventing pneumococcal disease in HIV-infected people is a subject of debate. We reviewed the clinical evidence for recommending PPV-23 for use in HIV-infected patients. MethodsA systematic search of peer-reviewed publications (EMBASE, the Cochrane Library, and PubMed/ BioMed Central), the Internet and grey literature was conducted. Three hundred and eighteen documents were reviewed. Studies reporting risk estimates for all-cause pneumonia, allpneumococcal disease, and/or invasive pneumococcal disease after PPV-23 immunization in HIV-infected adults were included. ResultsWe identified one randomized trial and 15 observational studies. While the randomized trial found a 60% increased risk of all-cause pneumonia among vaccinees, 11 of the 15 observational studies found various degrees of disease protection associated with PPV-23 immunization. However, most studies suffered from limited confounder control in their multivariate analyses, despite study data suggesting substantial differences between the characteristics of exposed and unexposed individuals. ConclusionsThe current clinical evidence provides only moderate support for PPV-23 immunization of HIVinfected adults. More data are needed on the efficacy of newer conjugated pneumococcal vaccines, which may be more immunogenic and could potentially replace PPV-23 in the future.

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“…Although cohort or population-based surveillance studies suggest that the incidence of invasive pneumococcal infections or pneumococcal pneumonia declines among HIV-infected patients with access to HAART and appropriate antimicrobial prophylaxis [2,4,6,7], it remains significantly higher among HIV-infected patients than in the general population, with risk ratios ranging from 35 to 60 [2][3][4]. In observational studies conducted in several developed countries, vaccination with 23-valent pneumococcal polysaccharide vaccine (PPV) has been shown to decrease the risk of invasive pneumococcal infections among HIVinfected patients [5,[8][9][10][11][12]. According to U.S. Public Health Service/Infectious Diseases Society of America (USPHS/ IDSA) guidelines, it is recommended that patients with HIV infection who have CD4 lymphocyte counts of 4200 cells/mL should receive 23-valent PPV, and revaccination can be considered for those patients who have initial CD4 counts of o200 cells/mL and whose CD4 counts increase to !…”

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confidence: 99%

A 5‐year longitudinal follow‐up study of serological responses to 23‐valent pneumococcal polysaccharide vaccination among patients with HIV infection who received highly active antiretroviral therapy^*

Chang

et al. 2009

HIV Medicine

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BackgroundLong-term antibody responses to 23-valent pneumococcal polysaccharide vaccine (PPV) among HIV-infected patients receiving highly active antiretroviral therapy (HAART) are rarely investigated. MethodsAntibody responses to three pneumococcal capsular polysaccharides [Pneumococcal polysaccharide (PPS) 14, 19F and 23F] were assessed among 169 HIV-infected patients who received HAART and 23-valent PPV. Patients were stratified into four groups according to CD4 count at vaccination: group 1, CD4o100 cells/mL (n 5 35); group 2, CD4 100-199 cells/mL (n 5 36); group 3, CD4 200-349 cells/mL (n 5 34); and group 4, CD4 ! 350 cells/mL (n 5 64). The proportion of patients who achieved increases in antibody titres of twofold or greater from baseline values (responders) was compared among the four groups of patients for five consecutive years after vaccination. ResultsThe proportion of responders to the three serotypes was significantly lower among patients in group 1 compared with those in the other three groups during yearly follow-up. Much faster loss of antibody responses was observed in group 1, although the rate of decline varied with the serotypes studied in the four groups. Compared with the nonresponders, more responders had CD4 counts 4100 cells/mL at vaccination and achieved better virological suppression throughout the 5-year period, while the absolute increases of CD4 cell counts after HAART were not statistically significantly different. ConclusionsDespite continued increases in CD4 cell counts after HAART, the proportion of HIV-infected patients who maintained antibody responses to PPV declined significantly over the 5-year follow-up period, especially among those who had CD4 counts o100 cells/mL at vaccination and who failed to achieve virological suppression. DOI: 10.1111/j.1468-1293.2009.00744.x HIV Medicine (2010 r 2009 British HIV Association 54 antiretroviral therapy (HAART) [1]. Although cohort or population-based surveillance studies suggest that the incidence of invasive pneumococcal infections or pneumococcal pneumonia declines among HIV-infected patients with access to HAART and appropriate antimicrobial prophylaxis [2,4,6,7], it remains significantly higher among HIV-infected patients than in the general population, with risk ratios ranging from 35 to 60 [2][3][4]. In observational studies conducted in several developed countries, vaccination with 23-valent pneumococcal polysaccharide vaccine (PPV) has been shown to decrease the risk of invasive pneumococcal infections among HIVinfected patients [5,[8][9][10][11][12]. According to U.S. Public Health Service/Infectious Diseases Society of America (USPHS/ IDSA) guidelines, it is recommended that patients with HIV infection who have CD4 lymphocyte counts of 4200 cells/mL should receive 23-valent PPV, and revaccination can be considered for those patients who have initial CD4 counts of o200 cells/mL and whose CD4 counts increase to ! 200 cells/mL after receipt of HAART and for those patients who have undergone pneumococcal polysaccharide v...

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Evaluation of Effectiveness of the 23-Valent Pneumococcal Capsular Polysaccharide Vaccine for HIV-Infected Patients

Cited by 161 publications

References 27 publications

Contribution of vaccines to our understanding of pneumococcal disease

Contribution of vaccines to our understanding of pneumococcal disease

The effectiveness of pneumococcal polysaccharide vaccination in HIV-infected adults: a systematic review

A 5‐year longitudinal follow‐up study of serological responses to 23‐valent pneumococcal polysaccharide vaccination among patients with HIV infection who received highly active antiretroviral therapy^*

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Evaluation of Effectiveness of the 23-Valent Pneumococcal Capsular Polysaccharide Vaccine for HIV-Infected Patients

Cited by 161 publications

References 27 publications

Contribution of vaccines to our understanding of pneumococcal disease

Contribution of vaccines to our understanding of pneumococcal disease

The effectiveness of pneumococcal polysaccharide vaccination in HIV-infected adults: a systematic review

A 5‐year longitudinal follow‐up study of serological responses to 23‐valent pneumococcal polysaccharide vaccination among patients with HIV infection who received highly active antiretroviral therapy*

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A 5‐year longitudinal follow‐up study of serological responses to 23‐valent pneumococcal polysaccharide vaccination among patients with HIV infection who received highly active antiretroviral therapy^*