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Pneumococcal conjugate vaccine (PCV) followed by pneumococcal polysaccharide vaccine (PPV) appears to be safe and effective for certain HIV-infected children, researchers report in the October issue of the Pediatric Infectious Disease Journal.
"The data from this study," lead author Dr. Mark J. Abzug told Reuters Health, "support use of a 3-part PCV-PCV-PPV regimen in HIV-infected children from 2 to 19 years of age who have not previously been vaccinated with PCV and who are on highly active antiretroviral therapy."
Dr. Abzug of the Children's Hospital, Denver, Colorado and colleagues studied 225 such children who received 2 doses of PCV and 1 dose of PPV at sequential 8-week intervals.
At entry, antibody concentrations were low although 75% of the children had previously had PPV. After vaccination, there a significant increase in serotype-specific antibody concentrations. Incremental gains were seen with each vaccine dose.
"The similarity of the response to pneumococcal vaccination in our population to that of HIV-uninfected children," continued Dr. Abzug, "is consistent with functional immune reconstitution in response to highly active antiretroviral therapy, with the recognized limitation that this conclusion is based on a quantitative rather than functional assessment of antibody production."
Analyses of predictors of vaccine response, he added, "suggest that changes in CD4% and HIV RNA level in response to highly active antiretroviral therapy may be more important factors affecting immune reconstitution than previous CD4% levels."
The key impact of viral load on the immune response to the vaccine series, Dr. Abzug concluded, "suggests that vaccination is optimal when viremia is maximally suppressed."
