Vaccine for Patients Infected with Human Immunodeficiency Virus Type 1: Clinical, Immunologic, and Virologic Responses

We determined the immunogenicity and safety of reimmunization with the 23-valent polysaccharide pneumo-coccal vaccine in patients infected with human immunodeficiency virus type 1 (HIV-1). Patients immunized 15 years earlier (initially within 1 year of HIV-1 seroconversion) were randomized to receive vaccine ( ) ornp 57 placebo (). Persons with recent HIV-1 seroconversion ( ) were immunized for the first time. Preim-np 30 np 14 munization levels of capsule-specific immunoglobulin G were similar in all groups. Reimmunized patients showed a significantly lower frequency and magnitude of antibody responses compared with persons with recent HIV-1 seroconversion. Reimmunized patients did not show adverse virologic or immunologic changes, but some reported local discomfort (15%) or fever (8%). Thus, the limited responses after reimmunization of HIV-1–infected patients with the current 23-valent vaccine mandates the need for a more effective reimmunization schedule, more immunogenic vaccines, or other behavioral and therapeutic interventions. Invasive pneumococcal disease is a significant cause of morbidity and mortality in the HIV type 1 (HIV-1)– infected population, occurring at rates up to 100-fol