Association of time since pneumococcal polysaccharide vaccine receipt and CD4 count with antibody response to the 13-valent pneumococcal conjugate vaccine in HIV-infected adults

Figures & data

Table 1. Demographics of study subjects.

	Group 1 Total	Group 1 PPV 1–3 yrs prior	Group 1 PPV >3 yrs prior	Group 1 CD4 <500 cells/mm^3	Group 1 CD4 >/=500 cells/mm^3	Group 2
n	96	42	54	37	59	49
Age in years
mean ± SD	44 ± 11˜	46 ± 11	42 ± 11	45 ± 10	43 ± 11	50 ± 11˜
range	20–65	22–65	20–62	26–63	20–65	21–71
Gender: no (%) male	66 (69%)	26 (62%)	40 (74%)	30 (81%)ˆ	36 (61%)ˆ	38 (78%)
Race
no (%) black	76 (79%)˜	33 (79%)	43 (80%)	28 (76%)	48 (81%)	27 (55%)˜
no (%) white	19 (20%)˜	9 (21%)	10 (19%)	1 (3%)	0 (0%)	22 (45%)˜
no (%) other	1 (1%)˜	0 (0%)	1 (2%)	8 (22%)	11 (19%)	0 (0%)˜
Body weight (lbs): mean ± SD	188 ± 47	188 ± 48	189 ± 47	188 ± 46	188 ± 48	189±52
No (%) prescribed a statin	23 (24%)	11 (26%)	12 (22%)	9 (24%)	14 (24%)	20 (41%)
No (%) with hx pneumonia	38 (40%)	15 (36%)	23 (43%)	22 (59%)ˆ	16 (27%)ˆ	23 (47%)
No (%) with diabetes	11 (11%)	5 (12%)	6 (11%)	2 (5%)	9 (15%)	10 (20%)
No (%) ever homeless	26 (27%)	12 (29%)	14 (26%)	10 (27%)	16 (27%)	8 (16%)
No (%) currently smoking	37 (39%)	15 (36%)	22 (41%)	16 (43%)	21 (36%)	22 (45%)
No (%) with hepatitis C	11 (11%)	6 (14%)	5 (9%)	4 (11%)	7 (12%)	12 (25%)
No (%) with AIDS diagnosis	57 (59%)	23 (55%)	34 (63%)	28 (76%)ˆ	29 (49%)ˆ	29 (59%)
No (%) on cART	100 (100%)	42 (100%)	54 (100%)	37 (100%)	54 (100%)	48 (98%)
CD4 count
mean + SD (cells/mm^3)	626 + 342	657 + 331	602 + 352	—	—	642 + 309
no (%) <200 cells/mm^3	11 (11%)	4 (10%)*	7 (13%)*	—	—	3 (6%)
no (%) 200–499 cells/mm^3	26 (27%)	8 (19%)*	18 (33%)*	—	—	16 (33%)
no (%) 500–799 cells/mm^3	34 (35%)	18 (43%)*	16 (30%)*	—	—	15 (31%)
no (%) >800 cells/mm^3	25 (26%)	12 (29%)*	13 (24%)*	—	—	15 (31%)
Time from PPV
no (%) 1–3 y	42 (44%)	—	—	12 (32%)	30 (51%)	27 (55%)
no (%) >3 y	54 (56%)	—	—	25 (68%)	29 (49%)	22 (45%)

SD = standard deviation, no = number, cART = combination antiretroviral therapy. Group 1 had serum taken before and 1 month after and Group 2 had serum taken 1 year after PCV-13 receipt. Comparisons were done by t-test for continuous variables, Fisher's exact test for binary variables, and Chi square test for categorical variables with >2 categories. Bold indicates variables with significant differences: ∼ p=0.003 for age and 0.001 for racial distribution between groups 1 and 2; *p=0.03 for CD4 count distribution between groups divided by PPV receipt; ^p=0.04 for gender, 0.002 for pneumonia history, and 0.01 for AIDS diagnosis between groups divided by CD4 count.

Figure 1. Antibody geometric mean concentrations (GMCs) for each serotype grouped by time since PCV-13 receipt. Bars represent 95% confidence intervals. †One year GMCs are from a different group of subjects (Group 2) than the baseline and one month GMCs (Group 1).

Figure 2. The geometric mean of the antibody concentrations at baseline (2A) and 1 month post –vaccination (2B), and the geometric mean of the fold-change in antibody concentrations (2C), according to time since PPV receipt by serotype. Bars represent 95% confidence intervals. There were 42 and 54 subjects in the 1–3 and >3 y since PPV receipt groups respectively. Of note, serotype 6A is included in PCV-13 but not PPV, but serotypes 3, 7F, and 19A are included in both PCV-13 and PPV.

Table 1 Post-PCV-13 antibody concentration and fold-rise in antibody concentration by time since PPV receipt and CD4 count.

	By Years Since Pneumovax Receipt				By CD4 Count at Vaccination
	1-3 years (n=42)	>3 years (n=54)	unadjusted p value	adjusted p value	<500 cells/mm3 (n=37)	>500 cells/mm3 (n=59)	unadjusted p value	adjusted p value
Serotype 3
Post Booster GMC (95% CI)	0.26 (0.17-0.41)	0.31 (0.22-0.44)	NS	NS	0.16 (0.11-0.25)	0.41 (0.30-0.57)	0.0008	0.01
Fold-rise geometric mean (95% CI)	3.24 (2.16-4.87)	4.32 (3.18-5.89)	NS	NS	3.17 (2.14-4.70)	4.28 (3.11-5.90)	NS	NS
Serotype 6A
Post Booster GMC (95% CI)	2.27 (1.43-3.61)	1.82 (1.40-2.37)	NS	NS	1.74 (1.19-2.55)	2.19 (1.58-3.05)	NS	NS
Fold-rise geometric mean (95% CI)	3.61 (2.46-5.29)	3.28 (2.40-4.49)	NS	NS	3.88 (2.48-6.07)	3.16 (2.39-4.17)	NS	NS
Serotype 7F
Post Booster GMC (95% CI)	1.00 (0.60-1.68)	1.25 (0.84-1.87)	NS	NS	0.81 (0.48-1.37)	1.41 (0.96-2.08)	NS (0.09)	NS
Fold-rise geometric mean (95% CI)	4.01 (2.70-5.94)	8.04 (4.8-13.47)	0.043	NS (0.06)	6.22 (3.96-9.76)	5.75 (3.54-9.34)	NS	NS
Serotype 19A
Post Booster GMC (95% CI)	2.97 (2.08-4.24)	3.55 (2.54-4.98)	NS	NS	2.34 (1.54-3.56)	4.06 (3.04-5.43)	0.03	NS (0.07)
Fold-rise geometric mean (95% CI)	1.99 (1.55-2.56)	2.69 (2.00-3.61)	NS	NS (0.09)	2.00 (1.49-2.68)	2.62 (2.00-3.42)	NS	NS

GMC = geometric mean concentration. CI = confidence interval. NS = nonsignificant. Adjusted p values were from multivariate regression models including the following covariates: age, gender, race, statin use, AIDS diagnosis, history of pneumonia, diabetes, history of homelessness, current smoking status, and hepatitis C coinfection. Of note, serotypes 3, 7F, and 19A are included in both PCV-13 and PPV, but 6A is only in PCV-13.

Figure 3. The geometric mean of the antibody concentrations at baseline (3A) and one month post –vaccination (3B), and the geometric mean of the fold-change in antibody concentrations (3C), according to CD4 count by serotype. Bars represent 95% confidence intervals. There were 11, 26, 34, and 25 subjects in the<200, 200–499, 500–799, and >800 CD4 cells/mm³ groups respectively.