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Article: Pneumococcal Vaccination in Patients Living with HIV

By: Marylee Worley, PharmD BCPS
South Florida – Southeast AIDS Education and Training Center

    HIV infection is associated with immunosuppression that increases the risk of invasive pneumococcal disease (IPD) with a 30 to 50 times higher risk of IPD compared to HIV uninfected populations.1,2 While the level of immunosuppression is an important risk factor for IPD, lower CD4 counts have also been associated with a poor immune response to the pneumococcal vaccine.3,4 Despite the decreased immune response to the pneumococcal vaccine in the severely immunocompromised, an attenuated response may still offer some protection in this high risk group.3,5 

    The current Advisory Committee on Immunization Practice (ACIP) and Infectious Diseases Society of America (IDSA) guidelines recommend the 13-valent pneumococcal conjugate vaccine (PCV13) followed by a booster vaccination with the PPSV23 in HIV-infected individuals. The current recommendations for patients 19 years or older are to administer one dose of PCV13 followed by PPSV23 at least 8 weeks after PCV13.2 In addition, it is recommended to administer a second dose of PPSV23 at least 5 years after the first dose of PPSV23 with no more than 3 lifetime doses of PPSV23. At the age of 65 if it has been more than 5 years since the second dose of PPSV23, a third dose is indicated.

    Adult Patients Living with HIV Pneumococcal Vaccination Recommendations

    References:

    1. Meiring S, Cohen C, Quan V, et al. (2016) HIV Infection and the Epidemiology of Invasive  Pneumococcal Disease (IPD) in South African Adults and Older Children Prior to the Introduction  of a Pneumococcal Conjugate Vaccine (PCV). PLoS ONE 11(2):e0149104.  doi:10.1371/journal.pone.0149104
    2.  Centers for Disease Control and Prevention. Use of 13-valent pneumococcal conjugate vaccine  and 23-valent pneumococcal polysaccharide vaccine for adults with immunocompromising  conditions: recommendations of the Advisory Committee on Immunization Practices  (ACIP). MMWR Morb Mortal Wkly Rep 2012; 61:816–9.
    3. Sadlier, C., O’Dea S., Bennett K., et al. Immunological efficacy of pneumococcal vaccine  strategies in HIV infected adults: a randomized clinical trial. Sci. Rep. 6, 32076; doi:  10.1038/srep32076 (2016).
    4. Lee KY, Tsai MS, Kuo KC, et al. Hum Vaccin Immunother. Pneumococcal vaccination among HIVinfected adult patients in the era of combination antiretroviral therapy. 2014;10(12):3700-10.
    5. French, N. Gordon SB, Mwalukomo T, et al. A trial of a 7-valent pneumococcal conjugate vaccine  in HIV-infected adults. N Engl J Med 362, 812–822, doi: 10.1056/NEJMoa0903029 (2010).