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IMMUNOGENICITY OF CONJUGATED AND POLYSACCHARIDE PNEUMOCOCCAL VACCINES ADMINISTERED DURING PREGNANCY OR POSTPARTUM TO WOMEN WITH HIV
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Abstract
Background. Pneumococcal vaccination is recommended in people with HIV, prioritizing PCV. We compared the immunogenicity
of PCV-10 and PPV-23 administered antepartum or postpartum.
Methods. This double-blind study randomized 346 pregnant women with HIV on antiretrovirals to PCV-10, PPV-23, or placebo
at 14–34 weeks gestational age. Women who received placebo antepartum were randomized at 24 weeks postpartum to PCV-10 or
PPV-23. Antibodies against 7 serotypes common to both vaccines and 1 serotype only in PPV-23 were measured by ELISA/chemiluminescence;
B- and T-cell responses to serotype 1 by FLUOROSPOT; and plasma cytokines/chemokines by chemiluminescence.
Results. Antibody responses were higher after postpartum versus antepartum vaccination. PCV-10 generated lower antibody
levels than PPV-23 against 4 and higher against 1 of 7 common serotypes. Additional factors associated with high postvaccination
antibody concentrations were high prevaccination antibody concentrations and CD4+ cells; low CD8+ cells and plasma HIV RNA;
and several plasma cytokines/chemokines. Serotype 1 B- and T-cell memory did not increase after vaccination.
Conclusions. Antepartum immunization generated suboptimal antibody responses, suggesting that postpartum booster doses
may be beneficial and warrant further studies. Considering that PCV-10 and PPV-23 had similar immunogenicity, but PPV-23 covered
more serotypes, use of PPV-23 may be prioritized in women with HIV on antiretroviral therapy.
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