Effect of human immunodeficiency virus type 1 infection on the antibody response to a glycoprotein conjugate pneumococcal vaccine: Results from a randomized trial

Adults (n = 282) were randomized to receive either a pneumococcal glycoprotein conjugate vaccine, composed of pneumococcal serotypes 6B, 14, 18C, 19F, and 23F linked to CRM(197), or a 23-valent pneumococcal polysaccharide vaccine. Among human immunodeficiency virus (HIV)-uninfected persons, conjugate vaccine elicited significantly higher IgG antibody geometric mean titers (GMTs) than did polysaccharide vaccine for serotypes 6B, 18C, and 23F: IgG GMTs were 9.0 versus 4.8, 23.2 versus 5.9, and 15.3 versus 4.4 mu g/mL, respectively. In contrast, the two vaccines elicited similar antibody GMTs in HIV-infected persons: GMTs ranged from 1.3 to 10.8 mu g/mL for all serotypes. Of note, among persons receiving polysaccharide vaccine, antibody GMTs in HIV-uninfected and -infected persons with CD4 lymphocytes greater than or equal to 500/mu L were similar. These data underscore the importance of controlled clinical evaluations of newer pneumococcal vaccines in all highrisk groups for whom pneumococcal immunization is recommended and highlight the need for early immunization of HIV-infected persons with currently available polysaccharide vaccines.