Effect of HIV-1 exposure and antiretroviral treatment strategies in HIV-infected children on immunogenicity of vaccines during infancy
Effect of HIV-1 exposure and antiretroviral treatment strategies in HIV-infected children on immunogenicity of vaccines during infancy
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DOI：
10.1097/qad.0000000000000127
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发表时间：
2014-02-20
期刊：
影响因子：
3.8
通讯作者：
Madhi, Shabir A.
中科院分区：
文献类型：
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作者：
Simani, Omphile E.;Izu, Alane;Madhi, Shabir A.
引言：我们研究了母亲HIV暴露和HIV感染婴儿抗逆转录病毒治疗（ART）时间对白喉-类毒素-破伤风-类毒素-全细胞百日咳和B型流感嗜血杆菌结合疫苗（HibCV）和单价B型肝炎疫苗（HBV）抗体应答的影响。方法：HIV感染（HEU）或HIV未感染（HUU）母亲所生的HIV未感染婴儿与CD 4（+）≥ 25%的HIV感染儿童平行入组，后者在确认HIV感染（ART-Immed）或临床和/或免疫学指征（ART-Def）时随机立即启动ART。婴儿在7.3、11.4和15.4周龄时接受三剂白喉-类毒素-破伤风-类毒素-wP-HibC/HBV。用Luminex多重免疫法检测白喉类毒素、破伤风类毒素、百日咳毒素、丝状血凝素（FHA）和B肝炎表面抗原（HBsAg）抗体，用标准ELISA法和杀菌法检测磷酸多核糖基核糖醇（PRP）抗体。对于所有疫苗，HUU和HEU婴儿的接种后GMC和血清保护性抗体水平或血清转换率的比例相似。HUU中破伤风类毒素、白喉类毒素、HBsAg和FHA的接种后GMC高于ART-Immed婴儿;破伤风类毒素、HBsAg和百日咳类毒素的接种后GMC高于ART-Def婴儿。然而，HUU和HIV感染婴儿在接种后产生血清保护性疫苗特异性抗体水平的比例没有差异。ART开始的时间通常不会影响HIV感染群体之间对疫苗的免疫反应。结论：与HUU儿童相比，早期ART开始的HEU和HIV感染婴儿接种DTwP-HibCV/HBV疫苗可获得相似的免疫力。
Introduction:We studied the effect of maternal HIV-exposure and timing of antiretroviral treatment (ART) in HIV-infected infants on antibody responses to combined diphtheria-toxoid-tetanus-toxoid-whole cell pertussis and Haemophilus influenzae type b conjugate vaccine (HibCV) and monovalent hepatitis B vaccine (HBV).Methods:HIV-uninfected infants born to HIV-infected (HEU) or HIV-uninfected (HUU) mothers were enrolled in parallel with HIV-infected children with CD4(+) >= 25%, who were randomized to initiate ART immediately upon confirmation of HIV-infection (ART-Immed) or when clinically and/or immunologically indicated (ART-Def). Infants received three doses of diphtheria-toxoid-tetanus-toxoid -wP-HibC/HBV at 7.3, 11.4 and 15.4 weeks of age. Antibody to diphtheria-toxoid, tetanus-toxoid, pertussis toxin, filamentous hemagglutinin (FHA) and hepatitis B surface antigen (HBsAg) were measured by Luminex multiplex-immunoassay and polyribosyl-ribitol phosphate (PRP) antibodies by standard ELISA and bactericidal assay.Results:Prevaccination antibody geometric mean concentrations (GMCs) were higher in HUU than HEU infants for tetanus-toxoid, but lower for HBsAg, diphtheria-toxoid and FHA. Postvaccination GMCs and proportion with seroprotective antibody levels or sero-conversion rates were similar between HUU and HEU infants for all vaccines. Postvaccination GMCs were higher in HUU for tetanus-toxoid, diphtheria-toxoid, HBsAg and FHA than ART-Immed infants; and for tetanus-toxoid, HBsAg and pertussis-toxoid than ART-Def infants. Nevertheless, there was no difference in proportion of HUU and HIV-infected infants who developed sero-protective vaccine-specific antibody levels postvaccination. The timing of ART initiation generally did not affect immune responses to vaccines between HIV-infected groups.Conclusion:Vaccination with DTwP-HibCV/HBV of HEU and HIV-infected infants initiated on early-ART confers similar immunity compared with HUU children.