Immunogenicity of Conjugated and Polysaccharide Pneumococcal Vaccines Administered During Pregnancy or Postpartum to Women With HIV

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.

Clinical trails registration: NCT02717494.

Keywords: ART; HIV infection; PCV; PPV; pregnancy.

© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

Figures

Figure 1.

Consort diagram.

Figure 2.

Antibody responses to PCV-10 and PPV-23 administered antepartum or postpartum. Data were derived from 336 women with HIV randomly assigned to PCV-10 antepartum (n = 115), PPV-23 antepartum (n = 115), PCV-10 postpartum (n = 53), and PPV-23 postpartum (n = 53). The following serotypes showed significant differences (P ≤ .03) in the unadjusted nonparametric comparison of week 4 postvaccination antibody concentrations antepartum versus postpartum: 1, PCV-10 and PPV-23; 4, PCV-10 and PPV-23; 5, PCV-10 and PPV-23; 7F, PPV-23; 14, PPV-23; 23F, PPV-23; and 33F, PPV-23. The following serotypes showed significant differences in the unadjusted comparison of PCV-10 versus PPV-23 antibody concentrations at 4 weeks after vaccination: 1, antepartum and postpartum; 4, antepartum and postpartum; 7F, postpartum; and 14, postpartum. Maternal geometric means and 95% confidence intervals are shown.