Richtlijn HIV
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Streptococcus pneumoniae (pneumokokken)

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''De tekst voor dit hoofdstuk is overgenomen uit de CBO/NVAB-richtlijn antiretrovirale behandeling en behoefde geen bijstelling:''
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*Pneumokokkenvaccinatie wordt bij alle mensen met hiv geadviseerd; in het bijzonder na eerdere pneumonie of invasieve pneumokokken infectie, bij mensen met COPD en i.v. drugsgebruikers.  
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*Pneumokokkenvaccinatie bestaat uit eerst een 13-valent geconjugeerd pneumokokkenvaccin, 8 weken later gevolgd door een 23-valent polysaccharide pneumokokkenvaccin, conform asplenie richtlijn.  
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*Voorkeur heeft om te wachten met vaccineren tot CD4 &gt; 200 en bij voorkeur ook een ondetecteerbare virale load.<br>  
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'''Aanbeveling'''
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*Indien patiënt eerst de vaccinatie met het 23-valente polysacharidenvaccin heeft ontvangen, dan adviseert de [https://clinicalinfo.hiv.gov/en/guidelines/adult-and-adolescent-opportunistic-infection/whats-new-guidelines DHHS richtlijn ]om het 13-valente conjugaatvaccin niet eerder dan 12 maanden erna toe te dienen. Dit is van toepassing bijv. bij patiënten die het polysacharidenvaccin hebben gekregen in het kader van het Het Nationaal Programma Pneumokokkenvaccinatie Volwassenen (NPPV).
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{| border="1" cellspacing="1" cellpadding="1" width="100%"
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| bgcolor="#cccccc" | Het is te overwegen is om HIV-geïnfecteerden met een gestoorde immuniteit, maar met meer dan 200 CD4 lymfocyten per mm<sup>3</sup>, met het pneumokokken polysaccharide vaccin te vaccineren.<br>In het bijzonder komen voor vaccinatie in aanmerking díe HIV-geïnfecteerden met het hoogste risico op een pneumokokkeninfectie zoals intraveneuze drug gebruikers en zij die eerder een pneumonie hebben doorgemaakt.
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<br>'''Literatuur'''
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*[http://www.ncbi.nlm.nih.gov/pubmed/8537687 Ahmed F, Steinhoff MC, Rodriguez-Barradas MC, et al. Effect of human immunodeficiency virus type 1 infection on the antibody response to a glycoprotein conjugate pneumococcal vaccine: results from a randomized trial. J Infect Dis 1996; 173: 83-90.]
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*[http://www.ncbi.nlm.nih.gov/pubmed/10232311 Anglaret X, Chene G, Attia A, et al. Early chemoprophylaxis with trimethoprim-sulphamethoxazole for HIV-1-infected adults in Abidjan, Cote d'Ivoire: a randomised trial. Cotrimo-CI Study Group. Lancet 1999; 353: 1463-8.] <br>
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=479%5Bpage%5D+AND+ballet%5Bauthor%5D&cmd=detailssearch Ballet JJ, Sulcebe G, Couderc LJ et al. Impaired anti pneumococcal antibody response in patients with AIDS related persistent generalized lymphadenopathy. Clin Exp Immunol 1987; 68: 479-87.]
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=2633%5Bpage%5D+AND+breiman%5Bauthor%5D&cmd=detailssearch Breiman RF, Keller DW, Phelan MA, et al Evaluation of effectiviness of the 23-valent pneumococcal capsular polysaccharide vaccine for HIV-infected patients. Arch Intern Med 2000; 160: 2633-8.] <br>
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=1191%5Bpage%5D+AND+brichacek%5Bauthor%5D&cmd=detailssearch Brichacek B, Swindells S, Janoff EN, Pirruccello S, Stevenson M. Increased plasma human immunodeficiency virus type 1 burden following antigenic challenge with pneumococcal vaccine. J Infect Dis 1996; 174: 1191-9.]
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=1%5Bpage%5D+AND+prevention+of+pneumococcal+disease+recommendations&TransSchema=title&cmd=detailssearch Centers for Disease Control and Prevention. Prevention of Pneumococcal Disease: recommendations of the advisory committee on immunization practices (ACIP). MMWR 1997; 46(RR-8): 1-24.] <br>
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=3214%5Bpage%5D+AND+Conaty%5Bauthor%5D&cmd=detailssearch Conaty S, Watson L, Dinnes J, Waugh N. The effectiveness of pneumococcal polysaccharide vaccines in adults: a systematic review of observational studies and comparison with results from randomised controlled trials. Vaccine 2004; 22: 3214-24.]<br>
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=719%5Bpage%5D+AND+De+Graeve%5Bauthor%5D&cmd=detailssearch De Graeve D, Beutels P. Economic aspects of pneumococcal pneumonia: a review of the literature. Pharmacoeconomics. 2004; 22: 719-40.]
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=794%5Bpage%5D+AND+dworkin%5Bauthor%5D&cmd=detailssearch Dworkin MS, Ward JW, Hanson DL, Jones JL, Kaplan JE, and the Adult And Adolescent Spectrum of HIV Disease project. Pneumococcal disease among HIV-infected persons: Incidence,risk factors, and impact of vaccination. Clin Infect Dis 2001; 32: 794-800.] <br>
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=393%5Bpage%5D+AND+Dworkin%5Bauthor%5D&cmd=detailssearch Dworkin MS, Williamson J, Jones JL, Kaplan JE and the adult and adulescent spectrum of HIV disease project. Prophylaxis with trimethoprim-sulfamethoxazole for HIV-infected-patients: impact on risk for infectious diseases. Clin Infect Dis 2001; 33: 393-8.]
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=545%5Bpage%5D+AND+feikin%5Bauthor%5D&cmd=detailssearch Feikin DR, Elie CM, Goetz MB, et al. Randomized trial of the quantitative and functional antibody responses to a 7-valent pneumococcal conjugate vaccine and/or 23-valent polysaccharide vaccine among HIV-infected adults. Vaccine 2001; 20: 545-53.]
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=137%5Bpage%5D+AND+feikin%5Bauthor%5D&cmd=detailssearch Feikin DR, Elie CM, Goetz MB, et al. Specificity of the antibody response to the pneumococcal polysaccharide and conjugate vaccines in human immunodeficiency virus-infected adults. Clin Diagn Lab Immunol 2004; 11: 137-41.]
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=445%5Bpage%5D+AND+feikin%5Bauthor%5D&cmd=detailssearch Feikin DR, Feldman C, Schuchat A, Janoff EN. Global strategies to prevent bacterial pneumonia in adults with HIV disease. Lancet Infect Dis 2004; 4: 445-50.] <br>
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=1683%5Bpage%5D+AND+french%5Bauthor%5D&cmd=detailssearch French N, Gilks CF, Mujugira A, Fasching C, O'Brien J, Janoff EN. Pneumococcal vaccination in HIV 1-infected adults in Uganda: humoral response and two vaccine failures. AIDS 1998; 12: 1683-9.]
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*[http://www.ncbi.nlm.nih.gov/pubmed/15272398 French N, Moore M, Haikala R, Käyhty H, Gilks CF. A case control study to investigate serologic correlates of clinical failure of 23-valent pneumococcal polysaccharide vaccine in HIV-1 infected Ugandan Adults. J Infect Dis 2004; 190: 707-12.]
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=2106%5Bpage%5D+AND+French%5Bauthor%5D&cmd=detailssearch French N, Nakiyingi J, Carpenter LM, et al. 23-valent pneumococcal polysaccharide vaccine in HIV-1-infected Ugandan adults: double blind, randomised and placebo controlled trial. Lancet 2000; 355: 2106-11.]
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=857%5Bpage%5D+AND+gebo%5Bauthor%5D&cmd=detailssearch Gebo KA, Moore RD, Keruly JC, Chaisson RE. Risk factors for pneumococcal disease in human immuno¬deficiency virus-infected patients. J Infect Dis 1996; 173: 857-862.]
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*Gezondheidsraad. Vaccinatie tegen pneumokokken bij ouderen en riscogroepen. Publicatienr 2003/10. Den Haag: Gezondheidsraad:2003.
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*Gezondheidraad 1990 Vroege medische interventies bij personen die met het AIDS-virus zijn geinfecteerd. Publicatienr 1990/…. Den Haag: Gezondheidsraad:1990.
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=1421%5Bpage%5D+AND+viral+load+response+to+a+pneumococcal+conjugate&TransSchema=title&cmd=detailssearch Goetz MB, Feikin DR, Lennox JL, et al. Viral load response to a pneumococcal conjugate vaccine, polysaccharide vaccine or placebo among HIV-infected patients. AIDS 2002; 16: 1421-3.]
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=1971%5Bpage%5D+AND+guerrero%5Bauthor%5D&cmd=detailssearch Guerrero M, Kruger S, Saitoh Akihiki. Pneumonia in HIV-infected patients: a case-control survey of factors involved in risk and prevention. AIDS 1999; 13: 1971-5.]
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*[http://www.ncbi.nlm.nih.gov/pubmed/1448121 Hardy WD, Feinberg J, Finkelstein DM, et al. A controlled trial of trimethoprim-sulfamethoxazole or aerosolized pentamidine for secondary prophylaxis of Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome. AIDS Clinical Trials Group Protocol 021. N Engl J Med 1992; 327: 1842-8.]
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*[http://www.ncbi.nlm.nih.gov/pubmed/3560380 Huang KL, Ruben FL, Rinaldo CR Jr, Kingsley L, Lyter DW, Ho M. Antibody responses after influenza and pneumococcal immunization in HIV infected homosexual men. JAMA 1987; 257: 2047-50.]
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=2006%5Bpage%5D+AND+Hung%5Bauthor%5D&cmd=detailssearch Hung CC, Chen MY, Hsieh SM et al. Clinical experience of the 23-valent capsular polysaccharide pneumococcal vaccination in HIV-1 infected patients receiving HAART: a prospect observational study. Vaccine 2004; 22: 2006-12.]
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=314%5Bpage%5D+AND+janoff%5Bauthor%5D&cmd=detailssearch Janoff EN, Breiman RF, Daley CL, Hopewell PC. Pneumococcal disease during HIV infection. Epidemiologic, clinical, and immunologic perspective. Ann Intern Med 1992; 117: 314-324.]
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=983%5Bpage%5D+AND+janoff%5Bauthor%5D&cmd=detailssearch Janoff EN, Douglas JM Jr, Gabriel M, Blaser MJ, Davidson AJ, Cohn DL, Judson FN. Class specific antibody response to pneumococcal capsular polysaccharides in men infected with human immunodeficiency virus type 1. J Infect Dis 1988; 158: 983-90.]
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=975%5Bpage%5D+AND+Janoff%5Bauthor%5D&cmd=detailssearch Janoff EN, Fasching C, Ojoo JC, O’Brien J, Gilks CF. Responsiveness of human immunodeficiency virus type-1 infected Keyan women with or without prior pneumococcal disease to pneumococcal vaccine. J Infect Dis 1997; 175: 975-8]  
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=1623%5Bpage%5D+AND+jordano%5Bauthor%5D&cmd=detailssearch Jordano Q, Falcó V, Almirante B et al. Invasive pneumococcal disease in patients infected with HIV: still a threat in the era of HAART. Clin Infect Dis 2004;38:1623-8.]
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*[http://www.ncbi.nlm.nih.gov/pubmed/12081007 Kaplan JE, Masur HE, Holmes KK, et al. Guidelines for preventing opportunistic infections among HIV-infected persons – 2002. MMWR 2002; 51(RR08): 1-52.]
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*[http://www.ncbi.nlm.nih.gov/pubmed/8863353 Katzenstein TL, Gerstoft J, Nielsen H. Assesment of plasma HIV RNA and CD4 cell counts after combined Pneumovax® and tetanus toxoid vaccination: no detectable increase in HIV replication 6 weeks after immunization. Scan J Infect Dis 1996; 28: 239-41.]
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*[http://www.ncbi.nlm.nih.gov/pubmed/2572650 Klein RS, Selwyn PA, Maude D, Pollard C, Freeman K, Schiffman G. Response to pneumococcal vaccine among asymptomatic heterosexual partners of persons with AIDS and intravenous drug users infected with human immunodeficiency virus. J Infect Dis 1989; 160: 826-31.]
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=524%5Bpage%5D+AND+kroon%5Bauthor%5D&cmd=detailssearch Kroon, FP, Dissel JT van, Ravensbergen E, Nibbering PH, Furth R van. Antibodies against pneumococcal polysaccharides after vaccination in HIV-infected individuals: five years follow-up of antibody concentrations Vaccine 1999; 18: 524-30.]
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*[http://www.ncbi.nlm.nih.gov/pubmed/11115712 Kroon FP, van Dissel JT, Ravensbergen E, Nibbering PH, van Furth R. Enhanced antibody response to pneumococcal polysaccharide vaccine after prior immunization with conjugate pneumococcal vaccine in HIV-infected adults. Vaccine 2000; 19: 886-94.]
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=469%5Bpage%5D+AND+Kroon%5Bauthor%5D&cmd=detailssearch Kroon FP, Dissel JT van, Jong JC de, Furth R van. Antibody response to influenza, tetanus and pneumococcal vaccines in HIV-seropositive individuals in relation to the number of CD4 lymphocytes. AIDS 1994; 8: 469-76.]
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*[http://www.ncbi.nlm.nih.gov/pubmed/8778589 Kroon FP, Furth R van, Bruisten SM. The effects of immunization in Human Immunodeficiency Virus type 1 infection. N Engl J Med 1996; 335: 817-8.]
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*[http://www.ncbi.nlm.nih.gov/pubmed/12373505 Kvale D, Aaberge IS, Frøland SS. Predictive value of immunologic parameters and HIV RNA in relation to humoral Pneumococcal polysaccharide vaccine responses in patients with HIV infection. Eur J Clin Microbiol Infect Dis 2002; 21: 688-90.]
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=1315%5Bpage%5D+AND+lindenburg%5Bauthor%5D&cmd=detailssearch Lindenburg CEA, Langendam MW, Van Benthem BHB, Miedema F, Coutinho RA. No evidence that vaccination with a polysaccharide pneumococcal vaccine protects drug users against all-cause pneumonia. AIDS 2001; 15: 1315-7.]
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=33%5Bpage%5D+AND+loeliger%5Bauthor%5D&cmd=detailssearch Loeliger AE, Rijkers GT, Aerts P, Been Tiktak A, Hoepelman AI, Dijk H van, Borleffs JC. Deficient anti¬pneumococcal polysaccharide responses in HIV seropositive patients. FEMS Immunol Med Microbiol 1995; 12: 33-41.]
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=517%5Bpage%5D+AND+pneumonia+in+HIV-infected&TransSchema=title&cmd=detailssearch López-Palomo C, Martín-Zamorano M, Benítez E, et al. Pneumonia in HIV-infected patients in the HAART era: incidence, risk, and impact of the pneumococcal vaccination. J Med Virol 2004; 72: 517-24.]
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=1253%5Bpage%5D+AND+differential+effect+of+human&TransSchema=title&cmd=detailssearch Mascart-Lemone F, Gerard M, Libin M, Crusiaux A, Franchioly P, Lambrechts A,Goldman M, Clumeck N. Differential effect of human immunodeficiency virus infection on the IgA and IgG antibody responses to pneumococcal vaccine. J Infect Dis. 1995; 172: 1253-60.]
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=1364%5Bpage%5D+AND+Mcellistrem%5Bauthor%5D&cmd=detailssearch McEllistrem MC, Mendelsohn AB, Pass MA, Elliott JA, Whitney CG, Kolano JA, Harrison LH. Recurrent in vasive pneumococcal disease in individuals with HIV infection. J Infect Dis 2002; 185: 1364-8.]
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=181%5Bpage%5D+AND+mientjes%5Bauthor%5D&cmd=detailssearch Mientjes GH, Spijkerman IJ, van Ameijden EJ., et al. Incidence and risk factors for pneumonia in HIV-infected and non-infected drug users. J Infect 1996; 32: 181-6.]
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=1309%5Bpage%5D+AND+Mundy%5Bauthor%5D&cmd=detailssearch Mundy LM Auwaerter PG, Oldbach et al. Community-acquired pneumonia: impact of immune status. Am J Respir Crit Care Med 1995; 152: 1309-15.]
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=158%5Bpage%5D+AND+Navin%5Bauthor%5D&cmd=detailssearch Navin TR, Rimland D Lennox JL et al. Risk factors for community-acquired pneumonia among persons infected with HIV. J Infect Dis 2000; 181: 158-64.]
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=287%5Bpage%5D+AND+negredo%5Bauthor%5D&cmd=detailssearch Negredo E, Domingo P, Sambeat MA, Rabella N, Vázquez G. Effect of pneumococcal vaccine on Plasma HIV-1 RNA of stable patients undergoing effective HAART. Eur J Clin Microbiol Infect Dis 2001; 20: 287-96.]&lt;br&gt;
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*[http://www.ncbi.nlm.nih.gov/pubmed/10225389 Nielsen H, Kvinesdal B Benfield TL, Lundgren JD, Konradsen HB. Rapid loss of specific antibodies after pneumococcal vaccination in patients with HIV-1 infection. Scan J Infect Dis 1998; 30: 597-601.]
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=182%5Bpage%5D+AND+nuorti%5Bauthor%5D&cmd=detailssearch Nuorti JP, Butler JC, Gelling L et al. Epidemiologic relation between HIV and invasive pneumococcal disease in San Francisco County, California. Ann Intern Med 2000;132:182-190.]
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*[http://www.ncbi.nlm.nih.gov/pubmed/2025948 Opravil M, Fierz W, Matter L, Blaser J, Lüthy R. Poor antibody response after tetanus and pneumococcal vaccination in immunocompromised, HIV infected patients. Clin Exp Immunol 1991; 84: 185-9.]
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*[http://www.ncbi.nlm.nih.gov/pubmed/11564590 Pierce AB, Hoy JF. Is the recommendation for pneumococcal vaccination of HIV patients evidence based? J Clin Virol 2001; 22: 255-61.]
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=1012%5Bpage%5D+AND+redd%5Bauthor%5D&cmd=detailssearch Redd SC, Rutherford III GW, Sande MA, et al. The role of Human Immunodeficiency Virus infection in Pneumococcal bacteremia in San Fransisco residents. J Infect Dis 1990; 162: 1012-7.]
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=438%5Bpage%5D+AND+rodriguez+barradas%5Bauthor%5D&cmd=detailssearch Rodriguez-Barradas MC, Alexandraki I, Nazir T, et al. Response of HIV-infected patients receiving HAART to vaccination with 23-valent pneumococcal polysaccharide vaccine. Clin Infect Dis 2003; 37: 438-47.]
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*Rodriguez-Barracadas MC, Petersen N. Do HIV-infected persons have an increased risk of pneumococcal disease following immunization with Pneumococcal polysaccharide vaccine. 39th Annual Meeting of the IDSA, San Fransisco October 25-28, 2001 (Abstract no 350).  
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*[http://www.ncbi.nlm.nih.gov/pubmed/8094271 Rose DN, Schechter CB, Sacks HS. Influenza and pneumococcal vaccination of HIV infected patients: a policy analysis. Am J Med 1993; 94: 160-8.]
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=1727%5Bpage%5D+AND+staprans%5Bauthor%5D&cmd=detailssearch Staprans SI, Hamilton BL, Follansbee SE, Elbeik T, Barbosa P, Grant RM, Feinberg MB. Activation of virus replication after vaccination of HIV 1 infected individuals. J Exp Med 1995; 182: 1727-37.]
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*[http://www.ncbi.nlm.nih.gov/pubmed/10903221 Sullivan JH, Moore RD, Keruly JC, Chaisson RE. Effect of antiviral therapy on the incidence of bacterial pneumonia in patients with advanced HIV infection. Am J Respir Crit Care Med 2000; 162: 64-7.]
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=813%5Bpage%5D+AND+tasker%5Bauthor%5D&cmd=detailssearch Tasker SA, Wallace MR, Rubins JB et al. Reimmunization with 23-valent pneumococcal vaccine for patients infected with HIV type 1: clinical, immunologic and virologic responses. Clin Infect Dis 2002; 34: 813-21.]
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=471%5Bpage%5D+AND+Talesnik%5Bauthor%5D&cmd=detailssearch Talesnik E, Vial PA, Labarca J, Méndez C, Soza X. Time course of antibody response to tetanus toxoid and pneumococcal capsular polysaccharides in patients infected with HIV. JAIDS 1998; 19: 471-7.]
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*[http://www.ncbi.nlm.nih.gov/pubmed/8244356 Unsworth DJ, Rowen D, Carne C, et al. Defective IgG2 response to Pneumovax in HIV seropositive patients. Genitourin Med 1993; 69: 373-6.]
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=551%5Bpage%5D+AND+Vandenbruaene%5Bauthor%5D&cmd=detailssearch Vandenbruaene M, Colebunders R, Mascart-Lemone F et al. Equal IgG antibody response to pneumococcal vaccination in all stages of HIV disease. J Infect Dis 1995; 172: 551-3.]
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=1210%5Bpage%5D+AND+watera%5Bauthor%5D&cmd=detailssearch Watera C, Nakiyingi J, Miiro G et al. 23-valent pneumococcal polysaccharide vaccine in HIV-infected Ugandan adults: 6-year follow-up of a clinical trial cohort. AIDS 2004; 18: 1210-3.]
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*[http://www.ncbi.nlm.nih.gov/pubmed?term=1469%5Bpage%5D+AND+Wiktor%5Bauthor%5D&cmd=detailssearch Wiktor SZ, Sassan-Morokro M, Grant AD, et al. Efficacy of trimethoprim-sulphamethoxazole prophylaxis to decrease morbidity and mortality in HIV-1-infected patients with tuberculosis in Abidjan, Côte d'Ivoire: a randomised controlled trial. Lancet 1999; 353: 1469-75.] <br>
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Versie op 23 dec 2021 16:58

  • Pneumokokkenvaccinatie wordt bij alle mensen met hiv geadviseerd; in het bijzonder na eerdere pneumonie of invasieve pneumokokken infectie, bij mensen met COPD en i.v. drugsgebruikers.
  • Pneumokokkenvaccinatie bestaat uit eerst een 13-valent geconjugeerd pneumokokkenvaccin, 8 weken later gevolgd door een 23-valent polysaccharide pneumokokkenvaccin, conform asplenie richtlijn.
  • Voorkeur heeft om te wachten met vaccineren tot CD4 > 200 en bij voorkeur ook een ondetecteerbare virale load.
  • Indien patiënt eerst de vaccinatie met het 23-valente polysacharidenvaccin heeft ontvangen, dan adviseert de DHHS richtlijn om het 13-valente conjugaatvaccin niet eerder dan 12 maanden erna toe te dienen. Dit is van toepassing bijv. bij patiënten die het polysacharidenvaccin hebben gekregen in het kader van het Het Nationaal Programma Pneumokokkenvaccinatie Volwassenen (NPPV).