dr. Achmad Zainudin Arif* dr. Iin Noor Chozin, SpP(K)** * Mahasiswa Program Pendidikan Dokter Spesialis Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Brawijaya ** Staf Bagian Pulmonologi dan Ilmu Kedokteran Respirasi Fakultas Kedokteran Universitas Brawijaya

Journal Reading

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Vaccination is immunization against infectious disease through the administration of vaccines for the production of active (protective) immunity in humans or other animals. A vaccine should stimulate a sufficient number of memory T and B lymphocytes to yield effector T cells and antibody-producing B cells from memory cells.

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Introduction

HAART reduce incidence of opportunistic-infections

in HIV-positive individuals invasive pneumococcal disease highly prevalent

35-50 times higher recommendation of revaccinating PCV13 PPV23 controversial efficacy, time to administration

The goal of the current study was to evaluate the impact of PPV23 revaccination in long term HAART cohorts

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Methods

Informed consent HIV-positive individuals on long term HAART (> 5 years) were recruited from the University of Toledo Medical Center.

HAART two nucleoside analog reverse transcriptase inhibitors (NRTI) and one non-nucleoside reverse transcriptase inhibitor (NNRTI) or a boosted protease inhibitor (bPI)

Responden were having first dose of PPV23 > 5 years ago and were eligible for PPV23 revaccination based on Advisory Committee on Immunization Practices (ACIP)

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Group A

CD4>200 cells/l (indicating immune restoration, n=29;

mean age: 49)

Group B

CD4

Labelling

PPS conjugation : PPS14 cascade blue (CB) ethylenediamine

(Invitrogen catalog C-621)

PPS23F 5-(4,6-dichlorotriazinyl) aminofluorescein (5-DTAF; Sigma-Aldrich #36565)

Cells were stained : anti-human CD19 (APC-Cy7)

CD27 (PerCP-Cy5.5)

IgM (APC)

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Baseline Characteristic

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Discussion

It is recommended that people at high risk for pneumococcal infection including the HIV-infected population, be revaccinated with PPV23 five years after primary vaccination

Data ?

HAART simultaneous improvement in antigen-specific B cell response to PPV23 ?

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Discussion

There was moderate to suboptimal change in IgG and IgM levels post vaccination against both PPS14 and 23F

OPT against serotype 14 and 23F were significantly higher pre- to post-vaccination in both group

reports that suggest PPV23 induces hyporesponsiveness conclusions were drawn solely on the basis of IgG levels

There was also differences in the distribution of PPS-specific B cells between HIV-negative and long term HAART cohorts

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Discussion

PPS-specific B cells to be predominantly of the IgM memory phenotype in HIV-negative volunteers pivotal role in protection against PPS

significantly lower percentages of PPS-specific IgM memory B cells in long term HAART cohorts despite PPV23 revaccination.

Positive correlations between the percentages and numbers of PPS-specific IgM memory B cells (but not unselected or other PPS-specific subsets) with OPT strongly suggests the importance of these cells in protection against S.pneumoniae

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Discussion

Depletion of specific memory B cell pools during the early stages of HIV infection culminated in attenuated response to vaccines or were risk factors for pneumococcal infections IgM memory B cells produce natural IgM which are efficient at clearing encapsulated organisms due to its superior complement fixing abilities

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Discussion

Influence of CD4 T cells in serological response to PPS assessed by comparing the response in group A (CD4>200) versus B (CD4

Discussion

HIV remain latent in secondary limphoid organ despite undetectable viral load and HAART

HIV early damage to key B cell subsets decreased response againts PPS

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Conclusion

PPV23 revaccination beneficial for HIV-positive HAART experienced individuals

Comparable OPT between patient groups indicate poor PPS-specific B cell reconstitution irrespective of the degree of T cell reconstitution post-HAART response lower compared with HIV negative individuals need for alternative approaches that can lead to a more robust response.

This findings emphasize the importance of evidence based vaccination practices for high risk individuals.

Administration of 13-valent pneumococcal conjugate vaccine (PCV-13) followed by a dose of PPV23 is now recommended

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Terima Kasih

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