A Double-Blind Placebo-Controlled Trial of the Safety and Immunogenicity of a Seven Valent Pneumococcal Conjugate Vaccine in Presumed HIV-Infected Infants

To assess whether HIV-infected infants who receive a heptavalent pneumococcal conjugate vaccine have more local reactions at the site of injection and systemic reactions than placebo subjects. To assess whether this vaccine is more immunogenic than placebo following the third vaccination.

Children with HIV infection are at increased risk for invasive pneumococcal infection, particularly bacteremia. A large proportion of pneumococcal disease is caused by a limited number of serotypes. The maximum number of pneumococcal serotypes that can be included in a new conjugate vaccine is felt to be limited by the amount of carrier protein. A heptavalent pneumococcal conjugate vaccine has been developed that consists of pneumococcal capsular saccharides from serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F bound to a diphtheria toxin mutant carrier protein.

Children with HIV infection are at increased risk for invasive pneumococcal infection, particularly bacteremia. A large proportion of pneumococcal disease is caused by a limited number of serotypes. The maximum number of pneumococcal serotypes that can be included in a new conjugate vaccine is felt to be limited by the amount of carrier protein. A heptavalent pneumococcal conjugate vaccine has been developed that consists of pneumococcal capsular saccharides from serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F bound to a diphtheria toxin mutant carrier protein.

Infants are randomized to receive either heptavalent pneumococcal conjugate vaccine or placebo by intramuscular injection at study months 0, 2, and 4, and then at 15 months of age. Additionally, patients receive PNU-IMUNE 23 ( pneumococcal polyvalent vaccine ) at 24 months of age.

Eligibility Criteria:
Inclusion Criteria

Concurrent Medication:

Allowed:

* Antipyretics for rectal temperature \>= 100.4 F.
* Antiretroviral therapy.

Patients must have:

* HIV positivity.
* Birth weight at least 1800 g (3.75 lb).
* Consent and compliance of parent or guardian.

NOTE:

* Coenrollment in other therapeutic protocols (except ACTG 218, 230, and 279) is permitted.

Exclusion Criteria

Co-existing Condition:

Patients with the following symptoms or conditions are excluded:

* Enrollment in HIV vaccine trials.
* Major congenital anomalies that are incapacitating, result in immunologic abnormalities, or require major surgical procedures.
* Congenital immunoglobulin deficiency, SS or SC hemoglobinopathy, or asplenia.
* Hypogammaglobulinemia.

Concurrent Medication:

Excluded:

* Prophylactic antipyretics.

Patients with the following prior conditions are excluded:

Acute moderate to severe intercurrent illness or fever within 72 hours prior to study entry.

Prior Medication:

Excluded:

* Any prior pneumococcal vaccine.
* Measles vaccine within 1 month prior to study vaccination.
* Any other routine vaccine within 1 week prior to study vaccination.
* Any immunosuppressant agent, including prednisone, for more than 6 weeks.

Prior Treatment:

Excluded:

* Blood products within 56 days prior to study vaccination.