Effectiveness of 23-valent polysaccharide pneumococcal vaccine on pneumonia in HIV-infected adults in the United States, 1998-2003

Centers for Disease Control and Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA.
Vaccine (Impact Factor: 3.62). 10/2008; 26(46):5830-4. DOI: 10.1016/j.vaccine.2008.08.032
Source: PubMed


Pneumococcal polysaccharide vaccine (PPV-23) has been recommended for HIV-infected adults. We investigated factors that could influence PPV-23 effectiveness against all-cause pneumonia in a longitudinal cohort of 23,255 HIV-infected adults receiving care during 1998--2003. Patients who received PPV-23 had a lower rate of pneumonia (IRR = 0.8; 95% CI: 0.8-0.9) than patients who had never been vaccinated, independent of recent CD4 count, HIV viral load, antiretroviral therapy, and history of pneumonia. However, PPV-23 provided no benefit when patients were vaccinated at HIV viral load > 100,000 copies/ml, irrespective of CD4 count at vaccination. Receipt of PPV-23 was associated with lower incidence of all-cause pneumonia.

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    • "By using the incidence of clinical disease, we found that the viral load at the time of PPV-23 immunization was the most significant predictor of PPV-23 failure to provide protection. This has been shown with other vaccines in HIV populations, in conjunction with CD4 cell count [18,21]. The effect of CD4 is more difficult to evaluate due to confounding use of antibiotic prophylaxis (usually including co-trimoxazole) against Pneumocystis Jirovecii pneumonia in patients with low CD4 counts. "
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