According to Prof Sipho Dlamini, Associate Professor, Division of Infectious Diseases & HIV Medicine – Groote Schuur Hospital, UCT, “In patients with HIV, the risk of pneumococcal disease is almost 100 times greater compared to those who do not have HIV. Even on antiretroviral therapy (ART), that risk goes down to about 35-40-fold greater than in those without HIV. ART doesn’t necessarily reduce the risk,” he said.
WHAT CAN BE DONE?
This is where vaccination comes in. The risk of pneumococcal disease in HIV is not only greater – the mortality and morbidity is high in this group of people. Globally, 1.6m people die of pneumococcal disease annually. This is a huge burden. In those not HIV infected, the greatest risk is in people younger than 2 and over 55.
HIV mostly affects young adults. This population group (young adults with HIV) is now greatly at risk and vaccination is important for them. “People who are HIV infected should be vaccinated for pneumococcal disease to be protected from suffering consequences of a severe disease.”
The vaccines available are PCV 13, a conjugate vaccine and the polysaccharide vaccine and PPV-23 the polysaccharide vaccine. The difference between the two is the serotypes covered. However, the conjugate vaccine is more immunogenic, and works better for weaker immune systems. Guidelines vary, but most recommend conjugate vaccine to be used in those who are HIV-infected.
You could follow with the polysaccharide vaccine about 8 weeks later. This would protect against a broader range of serotypes. The issue with vaccines for adults is that it isn’t covered by the state, as is the case in infants. “In an ideal world, we would advocate the conjugate vaccine first followed by the polysaccharide vaccine. This is the approach that the US has taken.”
He emphasised that if we use the polysaccharide vaccine only, most guidelines say this should only be used in HIV patients with a CD4 count of greater than 200. The conjugate vaccine can be used irrespective of CD4 count. “It is important that HIV-positive patients have a discussion about getting vaccinated. Which one to use will be determined by local guidelines and affordability,” he concluded.