Antibody to Capsular Polysaccharides of Streptococcus pneumoniae after Vaccination of Human Immunodeficiency Virus-Infected Subjects with 23-Valent Pneumococcal Vaccine

Abstract

The Centers for Disease Control recommends that, because of a greatly increased susceptibility to pneumococcal infection, all persons infected with human immunodeficiency virus (HIV) receive pneumococcal vaccine. Using an ELISA specific for antibody to capsular polysaccharide, a postvaccination antibody was evaluated to five commonly infecting serotypes of Streptococcus pneumoniae. Thirty-nine HIV-infected persons with ⩽500 CD4 cells exhibited significantly fewer responses than did healthy controls; overall, only 46 (24%) of 195 possible responses were positive compared with 45 (75%) of60 in 12 HIV-infected subjects with >500 CD4 cells and 92 (74%) of 125 in 25 healthy controls (P < .001). Subjects with ⩽500 CD4 cells responded to a mean of 1.1 antigens versus a mean of 3.8 and 3.7 in those with >500 CD4 cells and controls, respectively (P < .001). There were no differences between responses in those with <200 and those with 200–500 CD4 cells. Within groups stratified by CD4 cell counts, further stratification by clinical status did not reveal significant differences. Since asymptomatic HIV-infected persons with <500 CD4 cells show abnormal responses, pneumococcal vaccine should be given when HIV infection is first detected.