Long-Term Serological Response to 13-Valent Pneumococcal Conjugate Vaccine Versus 23-Valent Polysaccharide Vaccine in HIV-Infected Adults

Abstract

Introduction Long-term comparative immunologic response to 13-valent pneumococcal conjugate vaccine (PCV13) versus 23-valent polysaccharide vaccine (PPV23) among HIV-infected adults has not yet been investigated. Methods In this prospective pilot study, we quantified in HIV-positive adults serotype-specific IgG concentrations of the 12 pneumococcal serotypes shared by both vaccines 5 years after vaccination with two doses of PCV13 8 weeks apart (group 1) or one dose of PPV23 (group 2) and compared them with those assessed prior to vaccination (BL) and after 1 year (T1). Comparison of immunogenicity was based on geometric mean concentration (GMC), proportion of individuals with ≥ twofold increase from BL in specific antibody concentration against ≥ 2 serotypes and percentage of individuals with serotype-specific IgG ≥ 0.35 μg/ml, ≥ 1 μg/ml and ≥ individual serotype-specific correlates of protection. Results We included 91 subjects (median CD4 + 650 cells/µl, > 90% with HIV-RNA < 50 copies/ml); patients in groups 1 ( n = 42) and 2 ( n = 49) were homogeneous for the main characteristics. GMCs were significantly higher in the PCV13 group than in the PPV23 group for serotype 19F ( p = 0.003). Both vaccines revealed higher significant GMCs to most serotypes compared with BL, i.e., eight in group 1 vs. seven in group 2. With respect to T1, GMCs decreased significantly in the PCV13 group for eight vs. ten serotypes in the PPV23 group. More participants in the PCV13 group had ≥ 2 increase from BL in antibody levels to ≥ 2 serotypes compared with the PPV23 group (78.6% vs. 59.2%, p = 0.042). Overall, the percentage of subjects with serotype-specific IgG ≥ 0.35 μg/ml, ≥ 1 μg/ml and ≥ individual serotype-specific correlates of protection was similar between groups. Conclusion In this study with HIV-positive adults with a favorable viro-immunologic profile, both vaccines were shown to achieve a long-term durable serologic response. We found minor differences in immunogenicity between the two vaccines, which favored PCV13 over PPV23 5 years after immunization. Trial Registration ClinicalTrials.gov identifier, NCT02123433. Electronic supplementary material The online version of this article (10.1007/s40121-019-0256-z) contains supplementary material, which is available to authorized users.

Immunogenicity of pneumococcal vaccination in HIV infected individuals: A systematic review and meta-analysis

“…For PCV, results varied in two available studies. In the first study, SCRs dropped from to 22% to 4.8% [24] while in the second study high SCRs and SPRs persisted five years after initial vaccination; with a slight advantage for the group that received two PCV vaccinations instead of one (SCR 76% versus 62%) [46] . Of note, this study reported much higher initial SCRs compared to the first study.…”

“…Most studies (27/39) were cohort studies [5 , 13 . [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , 11/39 studies were RCTs [14 , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , and one study was a combination a cohort study and an RCT [57] . Only 8/39 studies included a HIV negative reference group [27 , 29 , 31 , 34 , [38] , [39] , [40] , 48] .…”

“…A more detailed description of the studies is provided in the supplementary data. In 23/39 studies, more than 75% of PLWH were treated with cART [5 , 13 , 14 , 24 , 25 , [27] , [28] , [29] , [30] , 32 , 33 , 35 , [37] , [38] , [39] , [40] , [41] , 43 , 44 , [46] , [47] , [48] , [52] , [53] , [54] , 56] and in 17/39 studies, the mean/median CD4 count was above 500 cells/mm 3 [5 , 13 , 23 – 25 , 27 , 28 , 35 , 38 , 39 , 43 – 45 , 47 , 48 , 52 , 55] . In only 3/39 studies, 100% of patients were treated with cART and had suppressed viral loads, reflecting the current standard of care [58] .…”

“…No studies reported on the long-term immunogenicity of a combination of PCV/PPSV23. Three studies investigated long term immunogenicity of either PPSV23 or one or two doses of PCV, five years after initial vaccination [24 , 32 , 46] . All were follow-up studies of the initial immunogenicity trials that were also included in this review ( Table 1 ).…”

“…All were follow-up studies of the initial immunogenicity trials that were also included in this review ( Table 1 ). Two studies reported on PPSV23 and showed a significant decay in antibody levels five years after vaccination, particularly when vaccinated had occurred at lower CD4-counts; one study showed a decrease in overall SCRs from 29% to 6.1%, while the second study showed that only 33% maintained a response to one out of three serotypes [24 , 32] . For PCV, results varied in two available studies.…”