In the bivariate and the multivariate linear regression taking duplication and IgG at least 1 μg/ml to a minimum of four serotypes as response criteria solely nadir CD4 cells count of at least 200 cells/μl (OR 2.34, 95% CI 1.14–4.81, P = 0.02) and not reporting previous pneumonia (OR 3.05, 95% CI 1.01–9.18, P = 0.04) were associated with response. Also, not reporting previous pneumonia was the only variable associated with response to a minimum of three serotypes in the bivariate and multivariate linear regression (OR 2.90, 95% CI 1.30–6.46, P = 0.01). No variable was associated with response to a minimum of five serotypes.
Before vaccination, the avidity indexes were very heterogeneous in each serotype (from 10% to 100%). No increases in avidity after 8 weeks were seen for any serotype in both vaccination groups. There was no correlation between avidity and antibody concentration either before vaccination or at 4 or 8 weeks for any serotype.
Although the present study only reflects the initial response to the two vaccination strategies, the CPV followed by PPV showed no advantage over the recommended PPV in IgG concentration or avidity against the CPV included serotypes in HIV-infected adults with moderate immunosuppression. Nevertheless, more interesting will be the persistence of specific antibodies in each group, the interval at which antibodies decrease to the prevaccine level and whether it could be a good indicator for revaccination. We can conclude that a sequential vaccination with both vaccines, CPV and PPV, does not improve, in terms of specific antibodies and avidity, the PPV in HIV-infected patients. As more data are known, CPV should not be recommended instead of PPV in this population.
Grant of the Funds in Sanitary Investigation of Spain (FISS), Instituto de Salud Carlos III (reference number PI070268).
Majorcan Pneumococcal Study Group: Bassa A, Cambra A, Campins A, Carratala C, Cifuentes C, Frontera G, García M, Hernandez RM, Homar F, Leyes M, Liebana A, Mila J, Morey C, Murillas M, Ortiz A, Pareja A, Payeras A, Peñaranda M, Ramirez A, Roca A, Ribas MA, Riera M, Samperiz G, Serra A, Serrano A, Villalonga C, Villoslada A.
Trial number: NCT00999739.
There are no conflicts of interest.
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