PNEUMOCOCCAL VACCINE AND HIV-INFECTION - REPORT OF A VACCINE FAILURE AND REAPPRAISAL OF ITS VALUE IN CLINICAL-PRACTICE

A clinical failure of pneumococcal vaccine is reported. A 22 year old African woman was given 23-valent pneumococcal vaccine at her initial presentation with HIV infection. She was asymptomatic and had a CD4 lymphocyte count above 500 cells/mm(3). Eighteen months later she died of meningitis and septicaemia due to Streptococcus pneumoniae type 9 (an antigen included in the 23-valent vaccine). Pneumococcal antibody levels performed on stored blood demonstrated no serological response to the vaccine. This is the first reported case of clinical failure of pneumococcal vaccine in an HIV infected patient who received vaccine whilst at the asymptomatic stage of HIV infection and with relatively intact immune function. The literature pertaining to pneumococcal vacc ination in the context of HIV infection was reviewed. Pneumococcal vac cination is recommended for HIV positive patients in the UK by the Dep artments of Health. It is likely that many physicians are not aware of these recommendations or are concerned about the poor efficacy of the vaccine, and it may consequently be underused in clinical practice. P ut the potential gain to the HIV positive patient is such that the vac cine should be offered to all HIV positive patients as soon as they pr esent for medical care, irrespective of the stage of HIV disease. Phys icians and patients should be aware that the vaccine is not fully prot ective and that episodes of sepsis, pneumonia and meningitis could sti ll be pneumococcal in origin and should be treated appropriately. Awar eness of the substantial risks of pneumococcal disease in HIV infected patients with prompt diagnosis and effective treatment is the most im portant strategy to decrease morbidity and mortality.