Pneumococcal Vaccine Safe, Effective in Adults With Stable HIV

By Marilynn Larkin

August 06, 2019

NEW YORK (Reuters Health) - Pneumococcal vaccination is safe and effective in people with HIV who are stable on antiretroviral therapy (ART), researchers say.

"Current guidelines recommend pneumococcal vaccination in HIV-positive patients. However, there were few data about viro-immunological outcomes in vaccinated patients," Dr. Silvia Nozza of San Raffaele Scientific Institute in Milan told Reuters Health by email.

"In our clinical cohort of (close to) 1,200 subjects, we did not observe significant virological and immunological failures," he said. "For this reason, we strongly recommend the vaccination. There are no reasons to not apply current guidelines."

Dr. Nozza and colleagues analyzed data from 1,197 ART-treated HIV-1 infected adults (median age, 50; 84% men) who had three consecutive determinations of HIV-RNA <50 copies/mL before administration of the 13-valent pneumococcal conjugate vaccine (PCV13), and two or more HIV-RNA values after vaccination.

As reported online July 10 in AIDS, at baseline, 960 participants (80.2%) had an undetectable viral load and 237 (19.8%) had residual viremia. The median CD4+ cell count was 705 cells/microliter and the median CD4+/CD8+ ratio was 0.82.

Compared to patients with viremia at baseline, patients with undetectable viral load were older; more often women; had a longer duration of HIV infection; had a longer duration of ART treatment and of virological suppression; and were more frequently treated with non-nucleoside reverse transcriptase inhibitor-based regimens.

During six months of follow-up (594 person-years of follow-up; PYFU), researchers confirmed 12 virologic failures and 35 viral blips.

Four virologic failures (0.4%) occurred among those with undetectable viremia at baseline and eight (3.4%) in those with residual viremia.

Similarly, eighteen viral blips (1.9%) versus 17 (7%) occurred among those with undetectable versus residual viremia at baseline.

Half (six) of the confirmed virologic failures were observed within one month, two between one-three months, and four between three-six months; five were reported to be associated with low ART adherence in the two months before viral blips and one with the occurrence of influenza.

The overall incidence rate of confirmed viral failure was 2.02 per 100-PYFU in those without residual virus versus 6.84 in those with it.

With respect to the 35 viral blips, three were observed within one month, nine between one and three months and 23 between three and six months. Seven were associated with low ART adherence in the two months before viral blips; six were recorded at the same time as the occurrence of influenzas; one was concurrent with pelvic inflammatory disease; one with syphilis and two with a recent cancer diagnosis. The reason was not reported for 18 participants.

The overall incidence rate of viral blips was 5.89 per 100-PYFU without residual virus and 14.5 with it.

Further, overall, the median CD4 change from baseline at six months was +10 cells/microliter; the median change in the CD4/CD8 ratio was +0.02.

Summing up, the authors stated, "Viral blips and confirmed virological failures were rarely observed in patients on stable virological suppression in the first six months following vaccination with PCV13. Additionally, no decrease of CD4 and CD4/CD8 ratio was recorded."

Dr. Jana Dickter, an infectious disease physician at City of Hope in Duarte, California, commented by email, "The Association for Professionals in Infection Control and Epidemiology started recommending both PCV13 and PPSV23 Pneumococcal 23 valent vaccines for individuals with HIV in 2012. PCV13 provides additional protection against certain serotypes of Pneumococcus that are known to cause invasive disease."

"Hopefully," she told Reuters Health, "this study reinforces for practitioners and HIV-infected patients the virologic and immunologic safety of this vaccine."

Dr. Louis Weiss, a professor of pathology and of medicine at Albert Einstein College of Medicine in New York City, added by email, "For clinicians, this article is helpful as it presents reassuring data that using PCV13 does not lead to immune activation that results in HIV adverse events - e.g., viral blips or ART failure."

The CSLHIV Cohort was supported in part by Gilead.


AIDS 2019.