Pneumococcal vaccination of HIV-infected individuals: safety and efficacy.

The finding of an increased risk of HIV-infected individuals for contracting pneumococcal diseases has led to the recommendation of antipneumococcal vaccination of HIV-infected individuals. However, due to reports of increased viral replication following immune stimulation, the vaccination policy has been called into question. The literature on changes in viral load and CD4 T cells following vaccination and the studies on the clinical efficacy of antipneumococcal vaccination is evaluated. It is concluded that the prevailing data do not lend support to the concern of a lasting effect of vaccination on viral load. Data on the clinical efficacy and serological responses of vaccination are too scanty to support the recommendation of antipneumococcal vaccination to HIV-infected individuals. In addition to the issue of clinical efficacy; many question remain to be addressed; for example, the protective antibody level, optimal timing and vaccination regimen are yet to be determined.