TY - JOUR
T1 - Antibody responses to hepatitis A virus vaccine in HIV-infected children with evidence of immunologic reconstitution while receiving highly active antiretroviral therapy
AU - Weinberg, Adriana
AU - Gona, Philimon
AU - Nachman, Sharon A.
AU - Defechereux, Patricia
AU - Yogev, Ram
AU - Hughes, Walter
AU - Wara, Diane
AU - Spector, Steven A.
AU - Read, Jennifer
AU - Elgie, Carol
AU - Cooper, Marlene
AU - Dankner, Wayne
N1 - Funding Information:
Received 18 April 2005; accepted 17 August 2005; electronically published 7 December 2005. Potential conflicts of interest: none reported. Financial support: Pediatric/Perinatal HIV Clinical Trials Network (contract HD-3-3345); National Institutes of Health. a Author affiliations and study group members are listed after the text. Reprints or correspondence: Dr. Adriana Weinberg, 4200 East Ninth Ave., Campus Box C227, Denver, CO 80262 (adriana.weinberg@uchsc.edu).
PY - 2006/1/15
Y1 - 2006/1/15
N2 - Background. Human immunodeficiency virus (HIV)-infected patients have weak responses to vaccines and may require revised immunization regimens. We investigated the safety and immunogenicity of 2 doses of hepatitis A virus (HAV) vaccine followed by a booster dose in HIV-infected children receiving stable highly active antiretroviral therapy. Methods. A total of 235 children with CD4+ T cell percentages ≥20% received 2 vaccine doses 24 weeks apart, and 117 received a third vaccine dose after 104 weeks. Anti-HAV antibody titers were measured at baseline and at 32, 104, and 112 weeks after the first vaccination. Subjects with antibody titers ≥20 mIU/mL were defined as being seropositive. High and low antibody responses were defined as titers ≥250 and <250 mIU/mL, respectively. Results. Of 151 subjects who were HAV seronegative at baseline, 97% seroconverted after 2 vaccine doses, and 47% had low antibody responses. At 104 weeks, 90% of subjects had antibody titers ≥20 mIU/mL, and those with low antibody responses were more likely to lose protective antibody titers. A third vaccine dose generated significantly higher antibody titers than those observed after the second vaccine dose. Undetectable HIV RNA at baseline was associated with higher anti-HAV antibody titers after the second vaccine dose. Antibody titers after the second and third vaccine doses were weakly correlated with CD4+ T cell percentages at the time when each vaccine dose was administered. In the 45 subjects who were HAV seropositive at baseline, responses to 2 and 3 vaccine doses were higher than those in subjects who were HAV seronegative at baseline, but the responses showed similar correlations. There were no serious adverse events associated with the vaccine. Conclusions. HIV-infected children with CD4+ T cell percentages ≥20% responded better to the HAV vaccine if they had undetectable HIV RNA. The standard 2-dose immunization regimen generated low antibody titers with limited persistence. A third vaccine dose was safe and increased the antibody titers, suggesting that an increase in immunizations may be warranted in this population.
AB - Background. Human immunodeficiency virus (HIV)-infected patients have weak responses to vaccines and may require revised immunization regimens. We investigated the safety and immunogenicity of 2 doses of hepatitis A virus (HAV) vaccine followed by a booster dose in HIV-infected children receiving stable highly active antiretroviral therapy. Methods. A total of 235 children with CD4+ T cell percentages ≥20% received 2 vaccine doses 24 weeks apart, and 117 received a third vaccine dose after 104 weeks. Anti-HAV antibody titers were measured at baseline and at 32, 104, and 112 weeks after the first vaccination. Subjects with antibody titers ≥20 mIU/mL were defined as being seropositive. High and low antibody responses were defined as titers ≥250 and <250 mIU/mL, respectively. Results. Of 151 subjects who were HAV seronegative at baseline, 97% seroconverted after 2 vaccine doses, and 47% had low antibody responses. At 104 weeks, 90% of subjects had antibody titers ≥20 mIU/mL, and those with low antibody responses were more likely to lose protective antibody titers. A third vaccine dose generated significantly higher antibody titers than those observed after the second vaccine dose. Undetectable HIV RNA at baseline was associated with higher anti-HAV antibody titers after the second vaccine dose. Antibody titers after the second and third vaccine doses were weakly correlated with CD4+ T cell percentages at the time when each vaccine dose was administered. In the 45 subjects who were HAV seropositive at baseline, responses to 2 and 3 vaccine doses were higher than those in subjects who were HAV seronegative at baseline, but the responses showed similar correlations. There were no serious adverse events associated with the vaccine. Conclusions. HIV-infected children with CD4+ T cell percentages ≥20% responded better to the HAV vaccine if they had undetectable HIV RNA. The standard 2-dose immunization regimen generated low antibody titers with limited persistence. A third vaccine dose was safe and increased the antibody titers, suggesting that an increase in immunizations may be warranted in this population.
UR - http://www.scopus.com/inward/record.url?scp=30944454860&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=30944454860&partnerID=8YFLogxK
U2 - 10.1086/498979
DO - 10.1086/498979
M3 - Article
C2 - 16362896
AN - SCOPUS:30944454860
SN - 0022-1899
VL - 193
SP - 302
EP - 311
JO - Journal of Infectious Diseases
JF - Journal of Infectious Diseases
IS - 2
ER -