Effectiveness of the polysaccharide pneumococcal vaccine among HIV-infected persons in Brazil: a case control study

Abstract Background Polysaccharide pneumococcal vaccine is recommended for use in HIV-infected adults in Brazil but there is uncertainty about its effectiveness in this patient population. The main objective of this study was to assess the effectiveness of the 23-valent polysaccharide pneumococcal vaccine against invasive pneumococcal infection among HIV-infected adult patients in São Paulo, Brazil. Methods A case-control study of 79 cases and 242 controls matched on CD4+ cell count and health care setting was conducted. Among HIV-infected adults in São Paulo, Brazil, with and without S. pneumoniae recovered from a normally sterile site; prior receipt of 23 valent polysaccharide pneumococcal vaccine was determined by review of medical records and patient interview. Results After adjustment for confounding factors, the point estimate for the effectiveness of 23 valent polysaccharide vaccine among HIV-infected adults against all invasive pneumococcal infection was 18% (95% CI: <0 to 62%). Conclusion We were unable to demonstrate a statistically significant protective effect of 23 valent polysaccharide against invasive pneumococcal infection vaccine among HIV-infected adults in Brazil. While the vaccine is relatively inexpensive and safe, its effectiveness among HIV-infected adults in Brazil is uncertain.

Investigators by institution:

Investigators by institution:

Regina Rocha Gomes de Lemos, Marileide Januaria de Vasconcelos, Luis Carlos Pereira, Jr., Francisco Bonasser Filho, Roberta Schiavon Nogueira, Lucas Alberto Medeiros, Simone and Erica (Emilio Ribas Infectious Diseases Institute); Ana Teresa Rodrigues Viso and Graça Maria A. Vasconcelos (CRT DST/AIDS); Sigrid Sousa Santos (HC FMUSP and Casa da AIDS) and Marise Oliveria Fonseca (Casa da AIDS); Augusto Penalva (HC UNICAMP); Joao Mendonça and Esper Kallas (HSPE); Maria Cristina Brandileone, Silvana Tadeu Casagrande and Maria Luisa L.S. Guerra (Aldolfo Lutz Insitute); João Renato Pinho and Monica Simone (Bioquemistry Laboratory Jardins) and Ana Lucia Schmidt and Gilberto Torquato (Federal University of São Paulo).

Regina Rocha Gomes de Lemos, Marileide Januaria de Vasconcelos, Luis Carlos Pereira, Jr., Francisco Bonasser Filho, Roberta Schiavon Nogueira, Lucas Alberto Medeiros, Simone and Erica (Emilio Ribas Infectious Diseases Institute); Ana Teresa Rodrigues Viso and Graça Maria A. Vasconcelos (CRT DST/AIDS); Sigrid Sousa Santos (HC FMUSP and Casa da AIDS) and Marise Oliveria Fonseca (Casa da AIDS); Augusto Penalva (HC UNICAMP); Joao Mendonça and Esper Kallas (HSPE); Maria Cristina Brandileone, Silvana Tadeu Casagrande and Maria Luisa L.S. Guerra (Aldolfo Lutz Insitute); João Renato Pinho and Monica Simone (Bioquemistry Laboratory Jardins) and Ana Lucia Schmidt and Gilberto Torquato (Federal University of São Paulo).

We also thank the following individuals for their assistance: Guido Levi, Vasco Pedroso de Lima, Andre de Felice (Emilio Ribas Institute); Arthur Kalichman and Maria Clara Gianna (CRT DST/AIDS); Reinaldo Salomão (Federal University of São Paulo); Rogério de Jesus Pedro (UNICAMP); Olavo Munhoz, Eliana Gutierrez and Aloísio Segurado (Casa da AIDS) and the Emilio Ribas Center for Studies (CEER).

We also thank the following individuals for their assistance: Guido Levi, Vasco Pedroso de Lima, Andre de Felice (Emilio Ribas Institute); Arthur Kalichman and Maria Clara Gianna (CRT DST/AIDS); Reinaldo Salomão (Federal University of São Paulo); Rogério de Jesus Pedro (UNICAMP); Olavo Munhoz, Eliana Gutierrez and Aloísio Segurado (Casa da AIDS) and the Emilio Ribas Center for Studies (CEER).

Financial Support:

Financial Support:

This study was funded by the Fogarty AIDS International Training and Research Program (AITRP) through the Division of Epidemiology, School of Public Health of the University of California, Berkeley (D43 TW00003). Logistical support from the Emilio Ribas Infectious Diseases Institute, the Adolfo Lutz Institute, São Paulo State STD/AIDS Reference and Training Center, the Clinical Hospital of São Paulo State University (UNICAMP), and the Casa da AIDS. The Foundation for the Coordination of Higher Education and Graduate Training (CAPES) of the Brazilian Ministry of Education supported the main author during doutoradosanduiche.

This study was funded by the Fogarty AIDS International Training and Research Program (AITRP) through the Division of Epidemiology, School of Public Health of the University of California, Berkeley (D43 TW00003). Logistical support from the Emilio Ribas Infectious Diseases Institute, the Adolfo Lutz Institute, São Paulo State STD/AIDS Reference and Training Center, the Clinical Hospital of São Paulo State University (UNICAMP), and the Casa da AIDS. The Foundation for the Coordination of Higher Education and Graduate Training (CAPES) of the Brazilian Ministry of Education supported the main author during "doutorado-sanduiche."