Cellular and humoral immune responses to a tetanus toxoid booster in perinatally HIV-1-infected children and adolescents receiving highly active antiretroviral therapy (HAART) Immunization in children with HIV seropositivity at birth: antibody response to polio vaccine and tetanus toxoid Impaired immunity to recall antigens and neoantigens in severely immunocompromised children and adolescents during the first year of effective highly active antiretroviral therapy. Quantitative and qualitative anamnestic immune responses to pneumococcal conjugate vaccine in HIV-infected and HIV-uninfected children 5 years after vaccination. Administration of live varicella vaccine to HIV-infected children with current or past significant depression of CD4(+) T cells. Immunogenicity of standard-titer measles vaccine in HIV-1-infected and uninfected Zambian children: an observational study. Persistence of vaccine-induced measles antibody beyond age 12 months: a comparison of response to one and two doses of Edmonston-Zagreb measles vaccine among HIV-infected and uninfected children in Malawi. Immunogenicity and immunologic memory after hepatitis B virus booster vaccination in HIV-infected children receiving highly active antiretroviral therapy. Serologic response to hepatitis B vaccine with high dose and increasing number of injections in HIV infected adult patients. HIV‐1‐infected children on HAART: Immunologic features of three different levels of viral suppression Antibody titers eight months after three doses of a five-valent pneumococcal conjugate vaccine in HIV and non-HIV-infected children less than two years of age. Long-term immunogenicity of a plasma-derived hepatitis B vaccine in HIV seropositive and HIV seronegative hemophiliacs. Persistent Humoral Immune Defect in Highly Active Antiretroviral Therapy–Treated Children With HIV-1 Infection: Loss of Specific Antibodies Against Attenuated Vaccine Strains and Natural Viral Infection Comparison of serologic responses to vaccination with one dose or two doses of 7-valent pneumococcal conjugate vaccine in HIV-infected adult patients. Safety and immunogenicity of 4 intramuscular double doses and 4 intradermal low doses vs standard hepatitis B vaccine regimen in adults with HIV-1: a randomized controlled trial. Long-term immunogenicity and efficacy of a 9-valent conjugate pneumococcal vaccine in human immunodeficient virus infected and non-infected children in the absence of a booster dose of vaccine. CPG 7909 adjuvant plus hepatitis B virus vaccination in HIV-infected adults achieves long-term seroprotection for up to 5 years. Early loss of measles antibodies after MMR vaccine among HIV-infected adults receiving HAART. Immunological Efficacy of a Three-Dose Schedule of Hepatitis A Vaccine in HIV-Infected Adults: HEPAVAC Study IgG antibody to pneumococcal capsular polysaccharide in human immunodeficiency virus-infected subjects: persistence of antibody in responders, revaccination in nonresponders, and relationship of immunoglobulin allotype to response. Plasma HIV-RNA Is the Key Determinant of Long-Term Antibody Persistence After Yellow Fever Immunization in a Cohort of 364 HIV-Infected Patients A prospective study of in vitro anti-HBs producing B cells (spot-ELISA) following primary and supplementary vaccination with a recombinant hepatitis B vaccine in insulin dependent diabetic patients and matched controls.
Background Human immunodeficiency virus type 1 ( HIV-1 ) infected children treated with highly active antiretroviral therapy ( HAART ) may develop a significant reduction of plasma viremia associated with an increase in CD4 + T-cell counts . Functional capacity of this reconstituted immune system in response to recall antigens is important to maintain protective immunity to vaccine-preventable diseases . We therefore determined cellular and humoral immune responses to tetanus toxoid ( TT ) booster in perinatally HIV-1-infected children and adolescents receiving HAART . Methods Immune responses were prospect ively evaluated pre- and post-tetanus booster using lymphocyte proliferation assay ( LPA ) stimulation index ( SI≥3.0 ) and tetanus antibody ( TAb≥0.15 ) in 15 patients . The median interval from primary tetanus immunization series was 6 years ( range 2–12 years ) . We compared patients by their virological response to HAART ( complete responders , CR , n=7 ; incomplete responders , ICR , n=8 ) . Results There were no significant differences in median age 12.6 years ( CR : 12.9 ; ICR : 10.6 ) or median CD4 T-cell pre-booster ( CR : 35%/819 ; ICR : 26%/429 ) between groups . Tetanus LPA responses were observed in one patient prior to booster and in seven patients post-booster . In contrast , 38 % of patients had protective TAb pre-booster , but 92 % developed protective TAb post-booster . All of the CR and 5/6 ICR patients developed protective TAb . Conclusions HIV-1-infected children and adolescents  had modest LPA responses to tetanus following booster , similar to HIV-1-infected adults . However , the majority of patients developed protective TAb levels after booster and maintained the response . Shorter intervals may need to be considered for TT immunization boosters in HIV-1-infected pediatric patients , as only 38 % had protective TAb at baseline Objective To evaluate the humoral response to routine childhood immunization of HIV-infected children . Design Response rate , antibody titres and persistence after polio and tetanus vaccination were compared in 72 children with HIV seropositivity at birth and divided according to HIV infection status as determined by clinical and laboratory tests . Methods Polio antibodies were titred in a microneutralization test ( positive titres , ≥1:4 ) , and antibody to tetanus toxoid with a passive haemagglutination method ( protective titres , ≥1:1024 ) . Results The response rates  to polio and tetanus vaccination ( > 80 and > 75 % ) were similar in the HIV-infected and non-infected children , as were antibody levels . In the subgroup with sera obtained some months after the last dose of vaccine , polio antibody levels decreased in all four HIV-infected and in three of the seven non-infected children ; protective tetanus antitoxin levels were detected in three of the six infected and in all three non-infected children . Conclusions This study demonstrates the ability of children with HIV infection to respond adequately to the two vaccines considered , although tetanus antitoxin levels were inferior , compared with those in the seroreverted children . The unsatisfactory antibody levels observed in the admittedly few HIV-positive children studied some months after the last vaccination could be the result of a lower initial protective level and not necessarily an expression of severely impaired immunocompetence . The administration of booster doses in addition to the traditional immunization schedule could be useful in children with HIV infection BACKGROUND We studied whether severely immunocompromised , human immunodeficiency virus (HIV)-infected children who were beginning highly active antiretroviral therapy ( HAART ) or changing HAART regimens could spontaneously respond to a recall antigen ( tetanus toxoid [ TT ] vaccine ) or respond to a recall antigen and neoantigen ( hepatitis A virus [ HAV ] vaccine ) after 3 vaccinations . METHODS A total of 46 children who had CD4 cell percentages < 15 % and who demonstrated a > 0.75-log reduction in plasma HIV RNA levels within 4 weeks of starting HAART were r and omized to receive vaccinations with either TT or HAV vaccines during the first 6 months of HAART . Study subjects then received the alternate vaccine during the next 6 months of HAART . RESULTS Despite the early decline in viremia and the later increase in the percentage of CD4 T cells , spontaneous recovery of cell-mediated immunity ( CMI ) was not seen for TT . Serologic responses to TT required 3 vaccinations and were comparable in both groups . Serologic responses to HAV were infrequent and of low titer , although the group that received HAV vaccine after receiving TT vaccine performed somewhat better . CMI to HAV was virtually absent . CONCLUSIONS Severely immunocompromised children who are receiving HAART develop CMI and antibody to a recall antigen independent of the timing of vaccination , but they require a primary series of vaccinations . Antibodies to a neoantigen , HAV , developed when vaccination was delayed after initiation of HAART . CMI to a neoantigen was difficult to establish . TRIAL REGISTRATION Clinical trials.gov identifier : NCT00004735/PACTG P1006 BACKGROUND Administration of pneumococcal conjugate vaccine ( PCV ) to HIV-infected children during infancy confers limited long-term protection in the absence of antiretroviral therapy . The objective of the present study was to determine the immune responses to PCV at 5 years of age in HIV-infected and HIV-uninfected children who had been primed with vaccine during infancy ( i.e. , previous vaccinees ) and in those receiving their first dose of vaccine ( i.e. , control subjects ) . METHODS Serotype-specific antibodies were quantified by enzyme immunoassay , and antibody functionality to serotypes 6B , 9V , and 19F were evaluated using an opsonophagocytic killing assay 1 month after vaccination . RESULTS Of the HIV-infected children , 19.7 % were receiving antiretroviral therapy , and 40.5 % had a CD4(+ ) cell percentage < 15 % .  Geometric mean concentrations of antibody and the proportion with a concentration 0.35 microg/mL after vaccination were greater among HIV-uninfected children than among HIV-infected children for both previous vaccinees and control subjects . Antibody concentrations after vaccination were lower for 3 of 7 serotypes among HIV-infected previous vaccinees than among control subjects . Detectable opsonophagocytic activity to all studied serotypes was lower among HIV-infected than among HIV-uninfected previous vaccinees and control subjects . Postvaccination antibody-mediated killing activity as determined by the opsonophagocytic killing assay was enhanced in control subjects compared with previous vaccinees among HIV-uninfected children . CONCLUSION HIV-infected vaccinees experience a partial loss of anamnestic responses to PCV . The optimal timing and frequency of booster vaccination as well as the responses to them among HIV-infected children need to be determined BACKGROUND Varicella can be a severe illness in human immunodeficiency virus (HIV)-infected children . The licensed , live attenuated varicella vaccine is safe and immunogenic in HIV-infected children with minimal symptoms and good preservation of CD4(+ ) T cells ( Centers for Disease Control and Prevention immunologic category 1 ) . METHODS To study the safety and immunogenicity of this vaccine in varicella-zoster virus (VZV)-naive , HIV-infected children with moderate symptoms and /or more pronounced past or current decreases in CD4(+ ) T cell counts , such children ( age , 1 - 8 years ) received 2 doses of vaccine 3 months apart . The children were observed in a structured fashion for adverse events . Blood was tested for VZV antibody and VZV-specific cell-mediated immunity ( CMI ) at baseline , 8 weeks after each dose , and annually for 3 years . Subjects who had no evidence of immunity 1 year after vaccination received a third dose and were retested . RESULTS The vaccine was well tolerated ; there were no vaccine-related , serious adverse events . Regardless of immunologic category , at least 79 % of HIV-infected vaccine recipients developed VZV-specific antibody and /or CMI 2 months after 2 doses of vaccine , and 83 % were responders 1 year after vaccination . CONCLUSIONS HIV-infected children with a CD4(+ ) T cell percentage of > or = 15 % and a CD4(+ ) T cell count of > or = 200 cells/ microL are likely to benefit from receiving varicella vaccine BACKGROUND Achieving the level of population immunity required for measles elimination may be difficult in regions of high human immunodeficiency virus type 1 ( HIV-1 ) prevalence , because HIV-1-infected children may be less likely to respond to or maintain protective antibody levels after vaccination . METHODS We conducted a prospect i ve study of the immunogenicity of st and ard-titer measles vaccine administered at 9 months of age to HIV-1-infected and uninfected children in Lusaka , Zambia . RESULTS From May 2000 to November 2002 , 696 children aged 2 - 8 months were enrolled . Within 6 months of vaccination , 88 % of 50 HIV-1-infected children developed antibody levels of > or=120 mIU/mL , compared with 94 % of 98 HIV-seronegative children and 94 % of 211 HIV-seropositive but uninfected children ( P=.3 ) . By 27 months after vaccination , however , only half of the 18 HIV-1-infected children who survived and returned for follow-up maintained measles antibody levels > or=120 mIU/mL , compared with 89 % of 71 uninfected children ( P=.001 ) and in contrast with 92 % of 12 HIV-1-infected children revaccinated during a supplemental measles immunization activity . CONCLUSIONS Although HIV-1-infected children showed good primary antibody responses to measles vaccine , their rapid waning of antibody suggests that measles vaccination campaigns may need to be repeated more frequently in areas of high HIV-1 prevalence BACKGROUND Previously , we demonstrated that measles antibody prevalence was lower at age 12 months among children infected with human immunodeficiency virus ( HIV ) than uninfected children following measles vaccination ( MV ) at ages 6 and 9 months . Among HIV-uninfected children , measles antibody prevalence was lower among 1- than 2-dose MV recipients . Here , we report results through age 24 months . METHODS Children born to HIV-infected mothers received MV at 6 and 9 months , and children of HIV-uninfected mothers were r and omized to MV at 6 and 9 months or MV at 9 months . We followed children through age 24 months . The child 's HIV status was determined and measles immunoglobulin G ( IgG ) level was measured by enzyme immunoassay ( EIA ) and by plaque reduction neutralization ( PRN ) on a subset . RESULTS Among HIV-uninfected children , the difference in measles antibody prevalence at age 12 months between one- and two-dose recipients reported previously by EIA was shown to be smaller by PRN . By age 24 months , 84 % and 87 % of HIV-uninfected children receiving 1 or 2 doses , respectively , were seroprotected . Only 41 % of 22 HIV-infected children were measles seroprotected at age 20 months . DISCUSSION Measles seroprotection persisted through age 24 months among HIV-uninfected children who received 1 or 2 doses of MV .  HIV-infected children demonstrated seroprotection through age 12 months , but this was not sustained BACKGROUND Hepatitis B virus ( HBV ) is an important cause of comorbidity in human immunodeficiency virus (HIV)-infected individuals . The immunogenicity of HBV vaccination in children receiving highly active antiretroviral therapy ( HAART ) was investigated . METHODS HIV-infected children receiving HAART who had low to moderate HIV loads and who had previously received 3 doses of HBV vaccine  were given an HBV vaccine booster . Concentrations of antibody to hepatitis B surface antigen ( anti-HBs ) were determined before vaccination and at weeks 8 , 48 , and 96 . A subset of subjects was administered a subsequent dose , and anti-HBs was measured before and 1 and 4 weeks later . RESULTS At entry , 24 % of 204 subjects were seropositive .  Vaccine response occurred in 46 % on the basis of seropositivity 8 weeks after vaccination and in 37 % on the basis of a 4-fold rise in antibody concentration . Of 69 subjects given another vaccination 4 - 5 years later , immunologic memory was exhibited by 45 % on the basis of seropositivity 1 week after vaccination and by 29 % on the basis of a 4-fold rise in antibody concentration at 1 week . Predictors of response and memory included higher nadir and current CD4 cell percentage , higher CD19 cell percentage , and undetectable HIV load . CONCLUSIONS HIV-infected children frequently lack protective levels of anti-HBs after previous HBV vaccination , and a significant proportion of them do not respond to booster vaccination or demonstrate memory despite receiving HAART , leaving this population insufficiently protected from infection with HBV Sixty-five HIV-infected patients received high-dose ( 40mug ) , short interval HBV vaccine . In non-responders to the initial immunization , 1 - 3 boosters were administered . Rate of response was 60.0 % after primary vaccination , and 89.2 % after boosters . However , 12 and 24 months after the last vaccination , only 63 % and 32.7 % of the responders , respectively , had persistence of protective anti-HBs titers ( > or = 10 IU/L ) . The results of logistic regression show that gender , CD4 count , and HIV viral load were significant predictors of vaccination outcome . This study suggests that in HIV-infected patients with relatively high CD4 count , response to high dose of HBV vaccine is suboptimal . Rate of response may be increased by vaccine boosts , but antibody titers are significantly lower in non-responders than in responders to primary vaccination . Since persistence of anti-HBs titers appears significantly related to antibody titers after the immunization procedure , monitoring of anti-HBs , particularly in patients with low level of protective antibody titers after primary vaccination or boosters , seems more than justified HIV‐1‐infected children show changes of blood lymphocyte sub population s. We have , therefore , investigated how highly active anti‐retroviral therapy ( ART ) alter these subsets . Blood sample s were taken from 41 HIV‐1‐infected children on ART who were divided into groups showing good , partial and poor responses to ART on the basis of viral load ( VL ) measurement in blood . The observations were compared to those seen in 20 uninfected children The objective of this study was to examine vaccine type-specific antibody titers eight months after a five-valent pneumococcal conjugate vaccine ( PCV ) in human immunodeficiency virus ( HIV ) and non-HIV-infected children under two years of age . Sixteen HIV-infected and 14 non-HIV-infected children under two years of age , and of similar age , race and sex distribution , received three doses ( separated by two months each ) of a five-valent oligosaccharide PCV ( types 6B , 14 , 18C , 19F , and 23F separately coupled to diphtheria CRM197 ) .  An additional 11 non-HIV-infected children , of similar demographic distribution to the PCV groups , received three doses of saline placebo . sera were collected just prior to , and at one and eight months after the three study drug doses . Serum vaccine type-specific pneumococcal IgG antibodies were measured by enzyme-linked immunoabsorbant assay ( ELISA ) . There was an impressive rise in antibody titers pre- to one month post-third PCV in both the HIV ( 58 - 970-fold ) and non-HIV-infected ( 19 - 553-fold ) children . There was a rapid and similar drop in antibody titers eight months after the PCV series for both HIV ( range 69 - 87 % drop ) and non-HIV-infected ( range 57 - 79 % drop ) subjects respectively . However , 46 % of the antibody titers from HIV-infected children and 62 % of the titers from non-HIV-infected children were still > 1.0 microgram ml-1 compared to placebo recipients for whom only 5 % of the titers were > 1.0 microgram ml-1 ( p < 0.05 ) . At the eight month post-PCV series blood draw , there were no significant differences in the GMTs , the percent drop in titers , or proportion of titers > 1.0 microgram ml-1 between the five HIV-infected children who had advanced ( CDC class : N3 , A3 , B2 - 3 , C1 - 3 ) compared to the 11 children with mild ( CDC class : N1 - 2 , A1 - 2 , B1 ) HIV disease at the time of their first PCV dose . Eight months after the PCV series , the proportion of titers ( combined all five serotypes ) > 1.0 microgram ml-1 was slightly , but significantly , lower for HIV-infected subjects ( 46 % ) compared to non-HIV-infected subjects ( 62 % ) ( p < 0.05 ) . These data are helpful in describing the kinetics of antibody responses to pneumococcal conjugate vaccines in both HIV and non-HIV-infected young children Short-term studies indicate that hepatitis B vaccines are safe and satisfactorily immunogenic in hemophiliacs . The duration of immunity in these immunocompromised patients , however , is not known . To determine this , we studied 78 hemophiliacs prospect ively 2 , 3 , and 4 years after the initial vaccination with a plasma-derived vaccine given as three monthly injections followed by a fourth booster injection at month 14 . The duration of immunity clearly depended on whether the patients were infected with the human immunodeficiency virus ( HIV ) . In HIV seronegative hemophiliacs ( n = 67 ) , there was a progressive decline in titers of antibody to the hepatitis B surface antigen ( anti-HBs ) , but antibody was still detectable 4 years later in all of them . From the curves of decline of antibody titers , it appears that there is no need to revaccinate patients for at least 5 to 6 years . The HIV seropositive hemophiliacs ( n = 11 ) not only started from much lower anti-HBs titers , but 5 of 11 lost anti-HBs . None of the 45 patients treated with concentrates during the postvaccination period developed serologic signs of hepatitis B , even though 6 of them had come into contact with live or inactivated hepatitis B virus as shown by the occurrence of spontaneous anamnestic antibody responses . This vaccine and schedule of vaccination afford a prolonged duration of immunity in HIV seronegative hemophiliacs , but HIV seropositive hemophiliacs have a risk of losing immunity early OBJECTIVE . In the pre – highly active antiretroviral therapy era , a loss of specific antibodies was seen . Our objective with this study was to describe the loss of specific antibodies during treatment with highly active antiretroviral therapy . METHODS . In a prospect i ve , single-center , cohort study of 59 children with HIV-1 infection , we investigated the long-term effect of highly active antiretroviral therapy on the titers and course of specific antibodies against measles , mumps , and rubella vaccine strains compared with wild-type varicella zoster virus , cytomegalovirus , and Epstein-Barr virus . RESULTS . During highly active antiretroviral therapy , age-adjusted CD4 + T cells and B cells increased , whereas total immunoglobulin levels declined . Although these children were preimmunized before the start of highly active antiretroviral therapy , only 24 ( 43 % ) had antibodies against all 3 measles , mumps , and rubella . Antibodies against measles , mumps , and rubella were lost in 14 ( 40 % ) , 11 ( 38 % ) , and 5 ( 11 % ) children who were seropositive at baseline . We also observed loss of varicella zoster virus immunoglobulin G in 7 ( 21 % ) of 34 , cytomegalovirus immunoglobulin G in 3 ( 7 % ) of 45 , but none of 53 Epstein-Barr virus – seropositive children . During highly active antiretroviral therapy , primary vaccination in 3 patients and 15 revaccinations in those with negative serology demonstrated incomplete seroconversion . CONCLUSIONS . Humoral reactivity in children with HIV-1 infection remains abnormal during highly active antiretroviral therapy . Despite immune reconstitution , antibodies against live-attenuated vaccine and wild-type natural virus strains disappear over time in up to 40 % of children with HIV-1 infection BACKGROUND Vaccination with 7-valent pneumococcal conjugate vaccine ( PCV ) has been shown to decrease the incidence of recurrent invasive pneumococcal disease among HIV-infected adults in Africa . Longitudinal follow-up studies of serologic responses to different doses of 7-valent PCV are rarely performed in HIV-infected adult patients receiving combination antiretroviral therapy ( cART ) . METHODS From October 2008 to June 2010 , 115 CD4-matched pairs of HIV-infected patients aged ≥ 20 years who had no prior pneumococcal vaccination received one or two doses of 7-valent PCV . Anticapsular antibodies against 4 serotypes ( 6B , 14 , 19F , and 23F ) were examined at the 12th , 24th , 36th , and 48th week following vaccination . Significant antibody responses were defined as ≥ 2-fold increase in the IgG level plus a post-vaccination antibody level ≥ 1000 ng/ml . RESULTS The most common reported adverse effects were injection site soreness ( 19.3 % ) and pain ( 4.8 % ) . Significant antibody response rate was highest for serotype 14 , followed by 23F , 19F , and 6B in all of the four time points examined . At week 48 , patients who received two doses of 7-valent PCV had a significantly higher response rate to serotype 6B ( P=0.03 ) and 23F ( P=0.01 ) than those who received one dose ; moreover , the former group also had a higher response rate to at least one ( P=0.03 ) and two serotypes ( P=0.02 ) in intention-to-treat analysis than the latter group . CONCLUSIONS HIV-infected adult patients on cART who received two doses of 7-valent PCV achieved better serological responses to at least one serotype than those who received one dose during the 48 weeks of follow-up CONTEXT Alternative schedules more immunogenic than the st and ard hepatitis B vaccine regimen are needed in patients with human immunodeficiency virus 1 ( HIV-1 ) infection . OBJECTIVE To compare the safety and immunogenicity of 4 intramuscular double-dose and 4 intradermal low-dose regimens vs the st and ard hepatitis B vaccine regimen . DESIGN , SETTING , AND PARTICIPANTS An open-label , multicenter , 1:1:1 parallel-group , r and omized trial conducted between June 28 , 2007 , and October 23 , 2008 ( date of last patient visit , July 3 , 2009 ) at 33 centers in France with patients enrolled in French National Agency for Research on AIDS and Viral Hepatitis trials in adults with HIV-1 infection who were hepatitis B virus ( HBV ) seronegative and having CD4 cell counts of more than 200 cells/μL. INTERVENTION Patients were r and omly assigned to receive 3 intramuscular injections of the st and ard dose ( 20 μg ) of recombinant HBV vaccine at weeks 0 , 4 , and 24 ( IM20 × 3 group , n = 145 ) ; 4 intramuscular double doses ( 40 μg [ 2 injections of 20 μg ] ) of recombinant HBV vaccine at weeks 0 , 4 , 8 , and 24 ( IM40 × 4 group , n = 148 ) ; or 4 intradermal injections of low doses ( 4 μg [ 1/5 of 20 μg ] ) of recombinant HBV vaccine at weeks 0 , 4 , 8 , and 24 ( ID4 × 4 group , n = 144 ) . MAIN OUTCOME MEASURES Percentage of responders at week 28 , defined as patients with hepatitis B surface antibody ( anti-HBs ) of at least 10 mIU/mL in patients who received at least 1 dose of vaccine . Patients with missing anti-HBs titer measurement at the final follow-up visit at week 28 were considered as nonresponders in the primary ( efficacy ) analysis . RESULTS A total of 437 patients were r and omized to the 3 study groups , of whom 11 did not receive any vaccine . Of these , 396 had available anti-HBs titers at week 28 . The percentage of responders at week 28 was 65 % ( 95 % confidence interval [ CI ] , 56%-72 % ) in the IM20 × 3 group ( n = 91 ) , 82 % ( 95 % CI , 77%-88 % ) in the IM40 × 4 group ( n = 119 ) ( P < .001 vs IM20 × 3 group ) , and 77 % ( 95 % CI , 69%-84 % ) in the ID4 × 4 group ( n = 108 ) ( P = .02 vs IM20 × 3 group ) . No safety signal and no effect on CD4 cell count or viral load were observed . CONCLUSION In adults with HIV-1 , both the 4 intramuscular double-dose regimen and the 4 intradermal low-dose regimen improved serological response compared with the st and ard HBV vaccine regimen . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00480792 The long-term immunogenicity and vaccine efficacy ( VE ) of a 9-valent conjugate pneumococcal vaccine was studied in HIV infected and HIV non-infected children .  VE against vaccine-serotype invasive pneumococcal disease following 6.16 years of follow-up persisted in HIV non-infected children ( 77.8 % ; 95 % CI 34.4 - 92.5 compared to 83 % after 2.3 years of follow-up ) , and declined from 65 % to 38.8 % ( 95 % CI -7.8 to 65.2 ) in HIV infected children . HIV non-infected vaccinees had equal ( serotypes 4 , 6B , 14 , 19F ) or greater ( serotypes 9V , 18C , 23F ) proportions of serotype-specific antibody concentrations of > or = 0.2microg/ml to vaccine-serotypes analyzed compared to HIV infected vaccinees at 5.3 years of age BACKGROUND Human immunodeficiency virus (HIV)-infected persons are hyporesponsive to hepatitis B virus ( HBV ) vaccination . CPG 7909 is an oligodeoxynucleotide containing immunostimulatory CpG motifs that activate human B and plasmacytoid dendritic cells via Toll-like receptor 9 . We previously reported that addition of CPG 7909 to a commercial HBV vaccine enhanced the kinetics , magnitude , and longevity of the seroprotective response over 48 weeks . We now report data for the 5-year period following vaccination . METHODS A r and omized , double-blind , controlled trial was conducted to determine clinical safety and immunogenicity of HBV vaccine in adult HIV-infected subjects receiving effective antiretroviral therapy . HBV-susceptible subjects , one-half of whom had experienced previous vaccination failure , were vaccinated at 0 , 1 , and 2 months with a double adult dose of recombinant HBV vaccine , with or without 1 mg of CPG 7909 ( 19 subjects per arm ) . Titers of antibody to HBV surface antigen ( anti-HBs ) were measured at 6-month intervals for up to 60 months . RESULTS The proportion of participants achieving and retaining seroprotection ( surface antibody titers , > or = 10 mIU/mL ) was greater in CPG 7909 recipients ( P < .05 at all time points ) . Geometric mean anti-HBs titers were higher in the CPG 7909 group than in the control group ( without CPG 7909 adjuvant ) at all measured time points . CONCLUSIONS The immunostimulatory properties of CPG 7909 present an important strategy in achieving long-term protection in HIV-infected patients and other HBV vaccine-hyporesponsive population OBJECTIVE The objective of the study was to evaluate the immune response to measles vaccine of HIV-infected adults in comparison to HIV non-infected adults . DESIGN We conducted a cross-sectional study to identify adults lacking measles antibodies . 26 HIV-infected patients and 22 controls found to be measles seronegative in the cross-sectional study , received the MMR vaccine . We prospect ively followed patients and measured measles antibodies , and cellular proliferative responses against measles antigens . We registered all adverse events at baseline , 3 and 12 months after vaccination . METHODS We determined measles antibodies by ELISA and cellular proliferative response in P BMC 's at baseline , and repeated measurements at 3 and 12 months after vaccination . RESULTS The humoral immune response to the vaccine between HIV-infected adults and the HIV-uninfected group was not statistically different at 3 months ( 81 % vs. 86 % respectively ) . One year after vaccination , a higher proportion of HIV-infected adults had lost measles antibodies in contrast to controls . The cellular response was not statistically different between the groups at baseline , 3 and 12 months after immunization despite the waning of antibodies at 12 months . No severe adverse events were observed . Most patients were receiving HAART and had a mean CD4 + cell count of 496 cells/mL. CONCLUSIONS The initial humoral immune response to measles vaccine was not different between HIV-infected adults and HIV-uninfected adults . However , HIV-infected adults have a rapid decline of measles antibodies despite their high CD4 + cell count and sustained cellular proliferative response Background : The immunogenicity of vaccines , including vaccine against hepatitis A virus ( HAV ) , is impaired in patients with HIV infection , requiring revised immunization regimens . Methods : We evaluated the immunological efficacy and safety of a 3-dose schedule of hepatitis A vaccine in HIV-infected adults . HAV-seronegative HIV-infected adults were r and omized to receive either 3 doses of 1440 UI of hepatitis A vaccine ( HAVRIX ; GlaxoSmithKline , Marly le Roi , France ) at weeks 0 , 4 , and 24 ( 46 patients ) or 2 doses 24 weeks apart ( 49 patients ) . Results : At week 28 , seroconversion , defined as an anti-HAV antibody ≥20 mIU/mL , occurred in 82.6 % and 69.4 % of patients in the 3-dose and the 2-dose group , respectively ( P = 0.13 , intent-to-treat analysis , missing data = nonresponder ) , and in 88.4 % and 72.3 % of patients in the 3-dose and the 2-dose group , respectively ( P = 0.06 , observed analysis ) . Only 37.9 % of patients experienced seroconversion after 1 vaccine dose ( intent-to-treat analysis ) . Anti-HAV antibody geometric mean titers were 323 and 132 mIU/mL in the 3-dose group and 138 and 67 mIU/mL in the 2-dose group , respectively , 28 ( P = 0.03 ) and 72 weeks ( P = 0.05 ) after the first vaccine dose . There were no serious adverse events associated with the vaccine . Multivariate analysis showed no treatment group effect but indicated that absence of tobacco smoking ( odds ratio = 2.92 , 95 % confidence interval : 1.07 to 7.97 ; P = 0.04 ) was an independent predictor of response to HAV vaccine . Conclusions : In HIV-infected adults , immunogenicity of hepatitis A vaccine is poor . Three doses of vaccine were safe and increased antibody titers Human immunodeficiency virus (HIV)-infected persons are less likely than are noninfected persons to respond to vaccination with pneumococcal polysaccharides ( PPS ) . Among those who respond , however , similar IgG levels may be achieved . HIV-infected men immunized with pneumococcal vaccine  were classified as high- or low-level responders ( IgG > or = 1 microgram/mL for > or = 3 of 5 PPS [ high ] or for < or = 1 PPS [ low ] ) . One and 2 years after immunization , geometric mean IgG levels and the percentages of subjects with IgG levels > or = 1 microgram/mL were similar for HIV-infected and for healthy high-level responders ( controls ) for all PPS except for serotype 8 . Among HIV-infected low-level responders , revaccination with a double dose of pneumococcal vaccine did not stimulate IgG responses . Responsiveness of HIV-infected white patients was significantly associated with the Km(1)- negative allotype . These findings support current general recommended guidelines for administering pneumococcal vaccine to HIV-infected persons . Nonresponders will not benefit from revaccination Background In HIV-infected patients , data on immunogenicity of Yellow fever immunization are scarce , and there is conflicting evidence of the influence of CD4 T-cell count and plasma HIV RNA on neutralizing antibody titer ( NT ) after vaccine injection . Methods In this prospect i ve cohort study , NT was measured in all consecutive HIV out patients who had previously received at least 1 injection of Yellow fever vaccine .  Risk factors for vaccine failure ( NT < 1:10 ) and magnitude of NT according to date s of HIV diagnosis and immunization were assessed by logistic regression and general linear models . Results Among 364 included patients , 24 ( 7 % ) had NT < 1:10 after a mean delay of 8.4 years after immunization . Among patients immunized after HIV diagnosis ( n = 240 ) , NT < 1:10 was associated only with detectable plasma HIV RNA at immunization . Among 79 patients with primary vaccination after diagnosis of HIV infection , higher HIV RNA at immunization was the unique independent risk factor for NT < 1:10 [ adjusted odds ratio ( OR ) = 3.73 per log10 , 95 % confidence interval ( CI ) : 1.14 to 12.28 ] . Lower values of NT were independently associated with a shorter duration of undetectable plasma HIV RNA ( OR = 1.05 per year , 95 % CI : 1.005 to 1.09 ) and higher plasma HIV RNA ( OR = 0.91 per log10 , 95 % CI : 0.84 to 0.99 ) at immunization . Conclusions The key determinant of antibody response was the HIV replication status at immunization . No association was found between antibody response and CD4 T-cell count A prospect i ve study of the immune response after hepatitis B vaccination was carried out in 32 insulin dependent diabetes mellitus ( IDDM ) patients and their age and sex matched healthy controls . A sensitive , immunoenzymatic technique was used , able to detect in vitro specific antibody production by mitogen stimulated individual B cells . In-vivo serologic response after vaccination with a st and ard scheme ( 0 , 1 and 6 months ) of 20 micrograms recombinant hepatitis B ( HB ) vaccine was significantly impaired in the IDDM patients both with respect to the number of nonresponders ( 25 versus 3 % , P less than 0.05 ) and antibody titers reached ( 1,377 vs. 9,060 IU/L , P less than 0.05 ) . The total number of in vitro IgM- and IgG-class immunoglobulin producing B cells as detected by the spot-ELISA , was found to be comparable in both groups . Specific IgG anti-HBs ( and to a lesser extent IgM anti-HBs ) showed impairment in the diabetic population as a whole . The number of IgG anti-HBs producing B cells was markedly depressed one month following vaccination , which is probably a reflection of homing of B cells outside the circulation . Responding subjects were identified early during their vaccination by the detection of in vitro anti-HBs production using the spot-ELISA . Non-responding healthy subjects and IDDM patients as a group showed a low number of IgG anti-HBs spots , suggesting a reduced specific memory B cell frequency . In 13 of 15 hypo- and nonresponders with positive IgG anti-HBs spots supplementary vaccination(s ) result ed in improved anti-HBs levels
Vaccine-induced antibodies may wane more quickly in persons living with human immunodeficiency virus ( HIV ) than in healthy individuals .
We review ed the literature on vaccines routinely recommended in HIV-infected patients to estimate how seroprotection decreases over time in those who initially responded to immunization .