Equal IgG Antibody Response to Pneumococcal Vaccination in All Stages of Human Immunodeficiency Virus Disease

To evaluate the immunogenicity and safety of a 23-valent pneumococcal vaccine in human immunodeficiency virus (HIV)-seropositive patients, 80 men and 18 women received 1 dose of the vaccine (Pneumo 23; Pasteur Merieux MSD, Brussels). The total IgG antibody response against all 23 Streptococcus pneumoniae capsular antigens was measured. Antibody levels were expressed in arbitrary units per microliter, referring to a standard curve. Geometric mean titers of the total IgG capsular antibodies on the day of vaccination and 30-45 days later were compared. The ratios of titers after and before vaccination in patients with>500,200-500, and <200 CD41ymphocyteslp,L were 10, 10, and 12.6, respectively. Nonresponse (ratio <4) occurred in 17 % of patients and was unrelated to CD4 cell count. The vaccine was well tolerated; no serious side effects occurred. In 83 % of the patients with mv infection, the total antipneumococcal IgG level was higher after vaccination. Streptococcus pneumoniae is the most common cause of community-acquired pneumonia and the second most common cause of bacterial meningitis in the United States. Pneumococ-cal bacteremia-related mortality is high, even with appropriate therapy. The worldwide emergence of drug-resistant pneumo