Department of Internal Medicine, Clinical Immunology and Infectious Diseases, Reims University Hospital, Reims, France.
Plateforme d'Immunomonitoring Vaccinal, Laboratory of Immunology, Cochin Hospital and University Paris-Descartes, APHP, Paris, France.
Front Immunol. 2021 Dec 20;12:791147. doi: 10.3389/fimmu.2021.791147. eCollection 2021.
Patients living with HIV (PLHIV) are prone to invasive pneumococcal disease. The 13-valent conjugated pneumococcal vaccine (PCV13) is currently recommended for all PLHIV, followed in most guidelines by a 23-valent polysaccharide pneumococcal vaccine. Data are scarce concerning the immunological efficacy of PCV13 among PLHIV.
To assess the immunological response at one month, and the immunological protection at 1-, 6-, and 12 months in PLHIV with a CD4 cell count above 200 cells/µl after a single dose of PCV13, as measured by both ELISA and opsonophagocytic assay (OPA).
PLHIV with CD4 cell count >200 cells/µl were included. Specific IgG serum concentrations for eight serotypes by ELISA and seven serotypes by OPA were measured at baseline, 1-, 6-, and 12 months after the PCV13 vaccination. Global response was defined as a two-fold increase from baseline of specific IgG antibody levels (μg/ml) assayed by ELISA or as a four-fold increase in OPA titer from baseline, for at least five serotypes targeted by PCV13. Global protection was defined as an IgG-concentration ≥1 µg/ml by ELISA or as an opsonization titer ≥LLOQ by OPA for at least five tested serotypes targeted by PCV13. Factors associated with global response and global protection were assessed using logistic regression.
Of the 38 PLHIV included, 57.9% and 63.2% were global responders, 92.1% and 78.9% were globally protected at one month, and 64.7% and 55.9% were still protected at 12 months, by ELISA and OPA respectively. A CD4/CD8 ratio of >0.8 was significantly associated with a better global response by OPA (OR=6.11, p=0.02), and a CD4 nadir <200 was significantly associated with a poorer global response by ELISA (OR=0.22, p=0.04). A CD4 cell count nadir <200 and age over 50 years were associated with poorer global protection by OPA at M1 (OR=0.18, p=0.04) and M12 (OR= 0.15, p=0.02), respectively. Plasma HIV RNA viral load <40 copies/ml was significantly associated with a better global protection at M1 by ELISA and OPA (OR=21.33, p=0.025 and OR=8.40, p=0.04).
Vaccination with PCV13 in these patients induced immunological response and protection at one month. At one year, more than half of patients were still immunologically protected.
艾滋病毒感染者（PLHIV）易患侵袭性肺炎球菌病。目前建议所有 PLHIV 接种 13 价结合肺炎球菌疫苗（PCV13），随后大多数指南建议接种 23 价多糖肺炎球菌疫苗。关于 PLHIV 接种 PCV13 后的免疫效果数据很少。
评估 CD4 细胞计数 >200 个/µl 的 PLHIV 在接种 PCV13 后 1 个月、1 个月、6 个月和 12 个月时的免疫应答，通过 ELISA 和调理吞噬测定（OPA）分别测量八种血清型和七种血清型的特异性 IgG 血清浓度。
纳入 CD4 细胞计数>200 个/µl 的 PLHIV。在接种 PCV13 前、后 1 个月、6 个月和 12 个月，通过 ELISA 测量针对八种血清型的特异性 IgG 血清浓度，通过 OPA 测量针对七种血清型的特异性 IgG 血清浓度。全球反应定义为 ELISA 测定的特异性 IgG 抗体水平（μg/ml）比基线增加两倍，或 OPA 滴度比基线增加四倍，针对 PCV13 靶向的至少五种血清型。全球保护定义为针对至少五种经 PCV13 靶向的测试血清型，ELISA 测定的 IgG 浓度≥1 µg/ml 或 OPA 的调理作用滴度≥LLOQ。使用逻辑回归评估与全球反应和全球保护相关的因素。
在 38 名 PLHIV 中，57.9%和 63.2%是全球应答者，1 个月时，92.1%和 78.9%具有全球保护作用，12 个月时，分别有 64.7%和 55.9%仍具有保护作用，ELISA 和 OPA。CD4/CD8 比值>0.8 与 OPA 更好的全球反应显著相关（OR=6.11，p=0.02），CD4 最低点<200 与 ELISA 较差的全球反应显著相关（OR=0.22，p=0.04）。CD4 最低点<200 和年龄>50 岁与 OPA 在 M1（OR=0.18，p=0.04）和 M12（OR=0.15，p=0.02）时的全球保护作用较差相关。血浆 HIV RNA 病毒载量<40 拷贝/ml 与 ELISA 和 OPA 在 M1 时的更好的全球保护作用显著相关（OR=21.33，p=0.025 和 OR=8.40，p=0.04）。
这些患者接种 PCV13 后可在 1 个月内引起免疫应答和保护作用。在 1 年内，超过一半的患者仍具有免疫保护作用。
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