Pneumococcal vaccination in HIV-1-infected adults in Uganda: humoral response and two vaccine failures. NLM AIDSLINE Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.

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Pneumococcal vaccination in HIV-1-infected adults in Uganda: humoral response and two vaccine failures.

AIDS. 1998 Sep 10;12(13):1683-9. Unique Identifier : AIDSLINE MED/98435818
French N; Gilks CF; Mujugira A; Fasching C; O'Brien J; Janoff EN; Medical Research Council Programme on AIDS in Uganda, Uganda; Virus Research Institute, Entebbe.

Abstract: OBJECTIVES: To assess the feasibility of establishing a pneumococcal vaccine trial among HIV-1-infected adults in Uganda and to characterize their responses to 23-valent pneumococcal polysaccharide vaccine. DESIGN: An open-label pilot trial to assess recruitment and compliance of HIV-1-infected adults in Uganda to vaccination and to determine the immunogenicity of the vaccine. SETTING: A community clinic for HIV-1-infected adults in Entebbe, Uganda. METHODS: Levels of capsule-specific IgG to four common vaccine capsular serotypes were measured before vaccination and 1 month after vaccination. Subsequent rates of disease episodes and deaths, and immunologic responses in two vaccine failures, were followed. RESULTS: One month after-vaccination, both HIV-1-infected (n = 77) and seronegative control subjects (n = 10) demonstrated a significant rise in capsule-specific immunoglobulin G (IgG) for three of four serotypes tested, but levels were significantly lower among HIV-1-infected patients. In 149 patient-years of follow-up, two (2.6%) developed pneumococcal pneumonia, one bacteremic with serotype 1 and one non-bacteremic with serotype 13, a non-vaccine serotype; both patients showed inadequate killing of the organism in vitro. In this same follow-up period, 29 (38%) patients died. CONCLUSION: HIV-1-infected adults in Uganda are at high risk of pneumococcal disease and show a significant but suboptimal response to pneumococcal vaccine. Although reliable recruitment and follow-up of vaccinees is feasible, evaluation of vaccine efficacy may be compromised by limited responses to common vaccine serotypes, an unknown incidence of disease with non-vaccine serotypes, and a high rate of mortality unrelated to Streptococcus pneumoniae infection.
Keywords: CLINICAL TRIAL JOURNAL ARTICLE Adult Antibodies, Bacterial/BIOSYNTHESIS AIDS-Related Opportunistic Infections/*PREVENTION & CONTROL *Bacterial Vaccines/IMMUNOLOGY Blood Bactericidal Activity/IMMUNOLOGY Case Report Female Human *HIV-1 Male Middle Age Pilot Projects Pneumonia, Pneumococcal/*PREVENTION & CONTROL Sinusitis/COMPLICATIONS Streptococcus pneumoniae/*IMMUNOLOGY Support, Non-U.S. Gov't Support, U.S. Gov't, Non-P.H.S. Support, U.S. Gov't, P.H.S. UgandaKWDclinicaltrialjournalarticleadultantibodies,bacterial/biosynthesisaids-relatedopportunisticinfections/KWDprevention&controlKWDbacterialvaccines/immunologybloodbactericidalactivity/immunologycasereportfemalehumanKWDhiv-1malemiddleagepilotprojectspneumonia,pneumococcal/KWDprevention&controlsinusitis/complicationsstreptococcuspneumoniae/KWDimmunologysupport,non-uKWDsKWDgov'tsupport,uKWDsKWDgov't,non-pKWDhKWDsKWDsupport,uKWDsKWDgov't,pKWDhKWDsKWDuganda
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Copyright © 1999 - National Library of Medicine. Reproduced under license with the National Library of Medicine, Bethesda, MD.

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