Predictors of serological non-response to the 13-valent pneumococcal conjugate vaccine followed by the 23-valent polysaccharide vaccine among adults living with HIV

• Published in: Vaccine 2023-07, Vol.41 (30), p.4414-4421
• Main Authors: Tinggaard, Michaela, Slotved, Hans-Christian, Jørgensen, Charlotte Sværke, Kronborg, Gitte, Benfield, Thomas
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; AIDS; Antibodies; Antiretroviral agents; CD4 antigen; Confidence intervals; Conjugates; HIV; Human immunodeficiency virus; Immunization; Immunogenicity; Laboratories; People living with HIV; Plasma; Pneumococcal vaccines; Polysaccharides; Population studies; regression analysis; Response rates; Risk groups; Serology; Serotypes; Streptococcus infections; Streptococcus pneumoniae; vaccination; Vaccines; Variables
• ISSN: 0264-410X; 1873-2518
• DOI: 10.1016/j.vaccine.2023.06.021

People living with HIV (PLWH) have higher incidence of pneumococcal disease compared to people without HIV. Immunization with pneumococcal vaccines is recommended, but serological non-response to pneumococcal vaccination is common for largely unknown reasons. PLWH on antiretroviral treatment and no prior pneumococcal vaccination received the 13-valent pneumococcal conjugate vaccine (PCV13) followed 60 days later by the 23-valent polysaccharide vaccine (PPV23). Serological response was evaluated 30 days post-PPV23 by antibodies against 12 serotypes covered by both PCV13 and PPV23. Seroprotection was defined as a ≥2-fold rise to a level above 1.3 µg/ml in geometric mean concentration (GMC) across all serotypes. Associations with non-responsiveness were evaluated by logistic regression. Fifty-two virologically suppressed PLWH (median age of 50 years (IQR 44–55) and median CD4 count of 634 cells/mm3 (IQR 507–792)) were included. Forty-six percent (95 % CI 32–61, n = 24) achieved seroprotection. Serotypes 14, 18C and 19F had the highest, and serotypes 3, 4 and 6B the lowest GMCs. Pre-vaccination GMC levels less than 100 ng/ml were associated with increased odds of non-responsiveness compared to levels above 100 ng/ml (adjusted OR 8.7, 95 % CI 1.2–63.6, p = 0.0438). Less than half of our study population achieved anti-pneumococcal seroprotective levels following PCV13 and PPV23 immunization. Low pre-vaccination GMC levels were associated with non-response. Further research is required to optimize vaccination strategies that achieve higher seroprotection in this high-risk group.