Pneumococcal immunization in HIV-infected adults
- Patricia L Hibberd, MD, PhD
Patricia L Hibberd, MD, PhD
- Chair, Department of Global Health
- Boston University School of Public Health
Pneumococcal infections, including pneumonia and invasive disease such as bacteremia and meningitis, have been a major source of morbidity and mortality since the beginning of the HIV epidemic, leading many experts to endorse use of pneumococcal vaccine for primary prevention in HIV-infected patients . However, the efficacy of pneumococcal vaccine in this patient population has been debated for many years . In addition, pneumococcal vaccines are serotype-specific, so efficacy will also vary depending on the prevalent serotypes within the community.
This topic addresses data on the use of polysaccharide and conjugate pneumococcal vaccines in HIV-infected patients and suggestions for primary prevention. Data on the use of pneumococcal vaccines in the immunocompetent host are found elsewhere. Advice on the use of other vaccines in HIV-infected patients is discussed in detail elsewhere. (See "Immunizations in HIV-infected patients" and "Prevention of hepatitis B virus infection in the HIV-infected adult".)
EPIDEMIOLOGY OF PNEUMOCOCCAL DISEASE
Pneumococcal pneumonia and meningitis are leading causes of morbidity and mortality among HIV-infected patients worldwide and treatment is complicated by the increasing incidence of drug-resistant pneumococcal strains [3,4]. The overall incidence of invasive pneumococcal disease was 677 cases per 100,000 person-years in HIV-infected patients . The case fatality rate of invasive disease ranges from 8 percent with pneumococcal bacteremia to 50 percent with meningitis [5,6].
A retrospective study performed in San Francisco, prior to the era of potent antiretroviral therapy (ART), found that the rates of pneumococcal bacteremia were approximately 100-fold greater in HIV-infected patients compared with those who were not infected with HIV . In addition, recurrent invasive pneumococcal disease is common, occurring in up to 25 percent of patients within a year after the initial episode .
Risk factors — The most important risk factor for developing pneumococcal infections is the level of immunosuppression [7-10]. In one trial of pneumococcal vaccine efficacy, the vast majority of HIV-infected patients who developed invasive pneumococcal disease had a CD4 count <200 cells/mm3 .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- EPIDEMIOLOGY OF PNEUMOCOCCAL DISEASE
- Risk factors
- AVAILABLE VACCINE FORMULATIONS
- EFFICACY AND IMMUNOGENICITY OF PNEUMOCOCCAL VACCINATION
- Polysaccharide vaccine
- Conjugate vaccine
- VACCINE RECOMMENDATIONS
- Vaccine administration
- When to immunize
- ROLE OF PROPHYLAXIS AGAINST PNEUMOCYSTIS AND PNEUMOCOCCAL DISEASE
- ADVERSE EVENTS
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS