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Kampiire L, Archary M, Frigati L, Penazatto M, Brusamento S. Immunization for Children Living With HIV: A Scoping Review. J Pediatric Infect Dis Soc 2022; 11:159-171. [PMID: 34979038 DOI: 10.1093/jpids/piab119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Immunosuppression secondary to human immunodeficiency virus (HIV) increases the risk of vaccine-preventable diseases in children living with HIV (CLHIV). Although vaccines are cost-effective interventions, their efficacy, immunogenicity, safety, and persistence of post-vaccination immunity in CLHIV receiving antiretroviral therapy (ART) is unclear. We aimed at identifying existing scientific evidence on immunization of CLHIV generated in the last 10 years to identify the need for a systematic review. METHODS Studies were identified using a broad search strategy applied in multiple databases. Included studies involved CLHIV aged 0-10 years and presented outcomes on safety, efficacy, effectiveness, immunogenicity, and use of booster vaccines. RESULTS Nineteen publications were identified. There was variable immunogenicity to and efficacy of vaccines by HIV and ART status. All vaccines were safe. CONCLUSION The heterogeneity of available studies makes it complex to do a systematic review and meta-analysis. A more uniform approach to sampling and follow-up in future studies would make comparison and interpretation of results more robust.
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Affiliation(s)
- Leatitia Kampiire
- Africa Health Research Institute, Durban, South Africa.,Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
| | - Moherndran Archary
- Africa Health Research Institute, Durban, South Africa.,Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa.,King Edward VIII Hospital, Durban, South Africa
| | - Lisa Frigati
- Department of Paediatrics and Child Health, Tygerberg Children's Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Martina Penazatto
- Treatment and Care, Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Serena Brusamento
- Treatment and Care, Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
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Simani OE, Izu A, Nunes MC, Violari A, Cotton MF, Van Niekerk N, Adrian PV, Madhi SA. Effect of HIV exposure and timing of antiretroviral therapy initiation on immune memory responses to diphtheria, tetanus, whole cell pertussis and hepatitis B vaccines. Expert Rev Vaccines 2018; 18:95-104. [PMID: 30417710 DOI: 10.1080/14760584.2019.1547195] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES We evaluated memory responses and antibody persistence to diphtheria-toxoid, tetanus-toxoid, whole-cell-pertussis (DTwP), and Hepatitis-B vaccines in HIV-unexposed, HIV-exposed-uninfected and HIV-infected children previously randomized to initiate time-limited ART at 6-10 weeks (ART-Immed) or when clinically/immunologically indicated (ART-Def). METHODS All children received DTwP booster at 15-18 months. Antibodies were measured for pertussis-toxoid, filamentous haemagglutinin (FHA), diphtheria-toxoid, tetanus-toxoid, and hepatitis-B prior to booster, 1-2 weeks post-booster and at 24 months of age. RESULTS Pre-booster antibody GMC were lower in HIV-infected groups than HIV-unexposed children for all epitopes. Post-booster and at 24 months of age, the ART-Def group had lower GMCs and antibody proportion ≥0.1 IU/ml for tetanus-toxoid and diphtheria-toxoid compared to HIV-unexposed children. At 24 months of age, the ART-Immed group had higher GMCs, and more likely to maintain antibody titres ≥1.0 IU/ml to tetanus-toxoid and diphtheria-toxoid compared to HIV-unexposed children. Compared to HIV-unexposed children, at 15 and 24 months of age, persistence of antibody to HBsAg of ≥10 mIU/ml was similar in the ART-Immed group but lower among the ART-Def group. Antibody kinetics indicated more robust memory responses in HIV-exposed-uninfected than HIV-unexposed children to diphtheria-toxoid and wP. CONCLUSION HIV-infected children not on ART at primary vaccination had poorer memory responses, whereas HIV-exposed-uninfected children mounted robust memory responses.
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Affiliation(s)
- Omphile E Simani
- a Department of Science and Technology, Health Sciences , National Research Foundation:Vaccine Preventable Diseases University of the Witwatersrand , Johannesburg , South Africa.,b Health Sciences , Medical Research Council: Respiratory & Meningeal Pathogens Research Unit, University of the Witwatersrand , Johannesburg , South Africa
| | - Alane Izu
- a Department of Science and Technology, Health Sciences , National Research Foundation:Vaccine Preventable Diseases University of the Witwatersrand , Johannesburg , South Africa.,b Health Sciences , Medical Research Council: Respiratory & Meningeal Pathogens Research Unit, University of the Witwatersrand , Johannesburg , South Africa
| | - Marta C Nunes
- a Department of Science and Technology, Health Sciences , National Research Foundation:Vaccine Preventable Diseases University of the Witwatersrand , Johannesburg , South Africa.,b Health Sciences , Medical Research Council: Respiratory & Meningeal Pathogens Research Unit, University of the Witwatersrand , Johannesburg , South Africa
| | - Avy Violari
- c Health Sciences , Perinatal HIV Research Unit, University of the Witwatersrand , Johannesburg , South Africa
| | - Mark F Cotton
- d Family Clinical Research Unit, Department of Pediatrics and Child Health, Medicine and Health Sciences , Stellenbosch University , Tygerberg , South Africa
| | - Nadia Van Niekerk
- a Department of Science and Technology, Health Sciences , National Research Foundation:Vaccine Preventable Diseases University of the Witwatersrand , Johannesburg , South Africa.,b Health Sciences , Medical Research Council: Respiratory & Meningeal Pathogens Research Unit, University of the Witwatersrand , Johannesburg , South Africa
| | - Peter V Adrian
- a Department of Science and Technology, Health Sciences , National Research Foundation:Vaccine Preventable Diseases University of the Witwatersrand , Johannesburg , South Africa.,b Health Sciences , Medical Research Council: Respiratory & Meningeal Pathogens Research Unit, University of the Witwatersrand , Johannesburg , South Africa
| | - Shabir A Madhi
- a Department of Science and Technology, Health Sciences , National Research Foundation:Vaccine Preventable Diseases University of the Witwatersrand , Johannesburg , South Africa.,b Health Sciences , Medical Research Council: Respiratory & Meningeal Pathogens Research Unit, University of the Witwatersrand , Johannesburg , South Africa
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Singh R, Mukherjee A, Singla M, Vajpayee M, Negi N, Kabra SK, Lodha R, Das BK. Impact of HIV infection and highly active antiretroviral therapy (HAART) on B cell subpopulations in children. J Med Virol 2018; 90:1222-1231. [PMID: 29575050 DOI: 10.1002/jmv.25074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 03/15/2018] [Indexed: 01/01/2023]
Abstract
B-cells play an important role in defending children against various infections. In view of scare data, we undertook this prospective cohort study to describe B cell compartment in HIV infected children (<5 years of age) and the effect of HAART on B cell subpopulations. HIV infected children (<5 years) from Pediatric HIV services of the Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, were recruited (April 2012-December 2015). The enrolled HIV-1 infected children (n = 59) were followed up regularly for 12 months; healthy controls (n = 51) included HIV uninfected children with no major illness. Flow cytometry was performed on fresh EDTA-treated blood samples to characterize B cell subpopulations. In HIV-infected children, marked depletion of naive (P = 0.003), non-switched memory (P = 0.02), mature (P = 0.0005), resting memory (P < 0.0001) B cells, and expansion of double negative memory (P < 0.0001), activated memory (P < 0.0001) and tissue like memory (P < 0.0001) B cells were observed as compared to healthy controls. In children started on HAART, at the end of 12 months of therapy, frequencies of non-switched memory (P = 0.04), switched memory (P = 0.01), and resting memory (P = 0.003) B cells were lower; activated memory (P = 0.04), and tissue-like memory (P = 0.0001) B cells were still higher than healthy controls. HIV infection resulted in reduced memory B cells in HIV infected children. Following HAART, there was normalization of some B cell subpopulations. The study emphasizes the need of re-vaccination in HIV infected children to maintain the memory B cell pool and adequate humoral immune response against infections.
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Affiliation(s)
- Ravinder Singh
- Department of Pediatrics, AIIMS, New Delhi, Delhi, India.,Department of Microbiology, AIIMS, New Delhi, Delhi, India
| | | | - Mohit Singla
- Department of Pediatrics, AIIMS, New Delhi, Delhi, India
| | - Madhu Vajpayee
- Department of Microbiology, AIIMS, New Delhi, Delhi, India
| | - Neema Negi
- Department of Microbiology, AIIMS, New Delhi, Delhi, India
| | - Sushil K Kabra
- Department of Pediatrics, AIIMS, New Delhi, Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, AIIMS, New Delhi, Delhi, India
| | - Bimal K Das
- Department of Microbiology, AIIMS, New Delhi, Delhi, India
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Moraes-Pinto MID, Ono E, Santos-Valente EC, Almeida LC, Andrade PRD, Dinelli MIS, Santos AMND, Salomão R. Lymphocyte subsets in human immunodeficiency virus-unexposed Brazilian individuals from birth to adulthood. Mem Inst Oswaldo Cruz 2014; 109:989-98. [PMID: 25424448 PMCID: PMC4325616 DOI: 10.1590/0074-0276140182] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 10/27/2014] [Indexed: 12/14/2022] Open
Abstract
Ethnic origin, genetics, gender and environmental factors have been shown to
influence some immunologic indices, so that development of reference values for
populations of different backgrounds may be necessary. We have determined the
distribution of lymphocyte subsets in healthy Brazilian individuals from birth to
adulthood. Lymphocyte subsets were determined using four-colour cytometry in a
cross-sectional study of 463 human immunodeficiency virus-unexposed children and
adults from birth through 49 years of age. Lymphocyte subsets varied according to
age, as previously observed in other studies. However, total CD4+ T cell
numbers were lower than what was described in the Pediatric AIDS Clinical Trials
Group P1009 (PACTG P1009), which assessed an American population of predominantly
African and Hispanic backgrounds until the 12-18 year age range, when values were
comparable. Naïve percentages and absolute values of CD8+ T cells, as
assessed by CD45RA expression, were also lower than the PACTG P1009 data for all
analysed age ranges. CD38 expression on both CD4+ and CD8+ T
cells was lower than the PACTG P1009 values, with a widening gap between the two
studies at older age ranges. Different patterns of cell differentiation seem to occur
in different settings and may have characteristic expression within each
population.
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Affiliation(s)
| | - Erika Ono
- Departamento de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | | | - Liziane C Almeida
- Departamento de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | | | | | | | - Reinaldo Salomão
- Departamento de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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Kernéis S, Launay O, Turbelin C, Batteux F, Hanslik T, Boëlle PY. Long-term immune responses to vaccination in HIV-infected patients: a systematic review and meta-analysis. Clin Infect Dis 2014; 58:1130-9. [PMID: 24415637 DOI: 10.1093/cid/cit937] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Vaccine-induced antibodies may wane more quickly in persons living with human immunodeficiency virus (HIV) than in healthy individuals. We reviewed the literature on vaccines routinely recommended in HIV-infected patients to estimate how seroprotection decreases over time in those who initially responded to immunization. For each study retrieved from the literature, the decrease of seroprotection was modeled with a log binomial generalized linear model, and data were pooled in a meta-analysis to provide estimates of seroprotection 2 and 5 years after the last vaccine administration. Our analyses confirmed that the duration of seroprotection was shorter in HIV-infected patients and that with current guidelines, a substantial proportion of patients would have lost protective antibodies before a booster was proposed. We therefore discuss the implications for the monitoring of antibody levels and timing of revaccination in these patients.
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6
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CD4+ T-cell activation impairs serogroup C Neisseria meningitis vaccine response in HIV-infected children. AIDS 2013; 27:2697-705. [PMID: 24149087 DOI: 10.1097/qad.0000000000000007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the influence of CD4 T-cell activation and regulatory populations in HIV-infected children antibody response to vaccination with a conjugate C polysaccharide vaccine. DESIGN CD4 T-cell activation was evaluated by expression of CD38, HLA-DR and CCR5 molecules. Regulatory CD4 T cells (TReg) were characterized as FoxP3CD127CD25 and inducer T cells (TInd) as CD4FoxP3CD25CD39. METHODS All patients (n = 36) were HIV-vertically infected, aged 2-17 years-old and were vaccinated with one vaccine injection. Blood samples were obtained before and after immunization to determine bactericidal antibody titers (SBA), CD4 T-cell activation and frequency of TReg and TInd subsets (multiparametric flow cytometry). RESULTS Children not-responding (n = 18) to MenC vaccine expressed higher frequency of activated CD4 T cells (HLA-DRCD38CCR5) than responders (n = 18), both before and after vaccination (P < 0.05). A significant higher frequency of TReg was detected in responders compared with nonresponders (P = 0.0001). We also detected an inverse correlation between CD4DRCD38CCR5 (P = 0.01) or CD4DRCD38 (P = 0.02) T cells and TReg cell frequency after vaccination. CD4 T-cell activation negatively correlated (P = 0.006) with postvaccination SBA titers but a positive correlation (P = 0.0001) was detected between TReg cells and SBA. TReg and TInd subsets were inversely correlated (P = 0.04). CONCLUSION Our findings suggest that higher CD4 T-cell activation leads to poor vaccine response in children living with HIV, which may be associated with a TReg/TInd disequilibrium.
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7
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Cagigi A, Cotugno N, Giaquinto C, Nicolosi L, Bernardi S, Rossi P, Douagi I, Palma P. Immune reconstitution and vaccination outcome in HIV-1 infected children: present knowledge and future directions. Hum Vaccin Immunother 2012; 8:1784-94. [PMID: 22906931 PMCID: PMC3656066 DOI: 10.4161/hv.21827] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 08/07/2012] [Accepted: 08/14/2012] [Indexed: 01/09/2023] Open
Abstract
Current evidence on routine immunization of HIV-1 infected children point out the need for a special vaccine schedule in this population. However, optimal strategies for identifying individuals susceptible to infections, and then offering them sustained protection through appropriate immunization schedule, both in terms of timing and number of vaccine doses, still remain to be elucidated. Understanding the degree of immune recovery after HAART initiation is important in guiding administration of routine vaccination in HIV-1 infected children. Although quantitative measures (e.g., CD4+ T-cell counts and immunoglobulin levels) are frequently performed to evaluate immune parameters, these measures do not fully mirror functional immune recovery. Here, we will review the status of single mandatory and recommended vaccines for HIV-1 infected children in relation to immune recovery after HAART initiation with the aim of identifying new means to help design personalized vaccine schedules for this population.
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Affiliation(s)
- Alberto Cagigi
- University Department of Pediatrics; DPUO; Unit of Immunology and Infectious Diseases; Children's Hospital Bambino Gesù; Rome, Italy
| | - Nicola Cotugno
- Chair of Pediatrics; University of Rome “Tor Vergata”; Rome, Italy
| | | | - Luciana Nicolosi
- Department of Pediatric Medicine; Bambino Gesù Children’s Hospital; Rome, Italy
| | - Stefania Bernardi
- University Department of Pediatrics; DPUO; Unit of Immunology and Infectious Diseases; Children's Hospital Bambino Gesù; Rome, Italy
| | - Paolo Rossi
- University Department of Pediatrics; DPUO; Unit of Immunology and Infectious Diseases; Children's Hospital Bambino Gesù; Rome, Italy
- Chair of Pediatrics; University of Rome “Tor Vergata”; Rome, Italy
| | - Iyadh Douagi
- Center for Hematology and Regenerative Medicine; Karolinska Institutet; Huddinge, Sweden
| | - Paolo Palma
- University Department of Pediatrics; DPUO; Unit of Immunology and Infectious Diseases; Children's Hospital Bambino Gesù; Rome, Italy
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8
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Vargas-Inchaustegui DA, Xiao P, Tuero I, Patterson LJ, Robert-Guroff M. NK and CD4+ T cell cooperative immune responses correlate with control of disease in a macaque simian immunodeficiency virus infection model. THE JOURNAL OF IMMUNOLOGY 2012; 189:1878-85. [PMID: 22798665 DOI: 10.4049/jimmunol.1201026] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Control of infectious disease may be accomplished by successful vaccination or by complex immunologic and genetic factors favoring Ag-specific multicellular immune responses. Using a rhesus macaque model, we evaluated Ag-specific T cell-dependent NK cell immune responses in SIV-infected macaques, designated "controlling" or "noncontrolling" based on long-term chronic viremia levels, to determine whether NK cell effector functions contribute to control of SIV infection. We observed that Gag stimulation of macaque PBMCs induced subset-specific NK cell responses in SIV-controlling but not SIV-noncontrolling animals, as well as that circulatory NK cell responses were dependent on Ag-specific IL-2 production by CD4(+) central memory T cells. NK cell activation was blocked by anti-IL-2-neutralizing Ab and by CD4(+) T cell depletion, which abrogated the Gag-specific responses. Among tissue-resident cells, splenic and circulatory NK cells displayed similar activation profiles, whereas liver and mucosal NK cells displayed a decreased activation profile, similar in SIV-controlling and -noncontrolling macaques. Lack of T cell-dependent NK cell function was rescued in SIV-noncontrolling macaques through drug-mediated control of viremia. Our results indicate that control of disease progression in SIV-controlling macaques is associated with cooperation between Ag-specific CD4(+) T cells and NK cell effector function, which highlight the importance of such cell-to-cell cooperativity in adaptive immunity and suggest that this interaction should be further investigated in HIV vaccine development and other prophylactic vaccine approaches.
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Maldonado Y. Measles Vaccine, HIV Infection, and Antiretroviral Therapy--A Window of Opportunity. J Infect Dis 2012; 206:466-8. [DOI: 10.1093/infdis/jis392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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10
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Menson EN, Mellado MJ, Bamford A, Castelli G, Duiculescu D, Marczyńska M, Navarro ML, Scherpbier HJ, Heath PT. Guidance on vaccination of HIV-infected children in Europe. HIV Med 2012; 13:333-6; e1-14. [PMID: 22296225 DOI: 10.1111/j.1468-1293.2011.00982.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2011] [Indexed: 02/02/2023]
Affiliation(s)
- E N Menson
- Department of General Paediatrics, Evelina Children's Hospital @St Thomas' Hospital, London, UK.
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Abstract
In summary, immunizations in special populations require understanding the underlying disease and how it might affect the immune system's ability to mount an antibody response to vaccines or predispose certain patient populations to developing certain serious infections. There is still a great need for research on the optimal timing of vaccines after transplants, how to assess protection and development of a protective antibody response after immunization, and whether certain groups (eg, HIV) need to be revaccinated after a certain amount of time if their antibody levels decline. In addition, there are limited data on efficacy of the newer vaccines in these special patient populations, which also requires further investigation.
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Affiliation(s)
- Michael A Miller
- Department of Pediatric Infectious Diseases and Immunology, University of Florida, Jacksonville, 32209, USA
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12
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de Moraes-Pinto MI. Interaction between pediatric HIV infection and measles. Future Virol 2011. [DOI: 10.2217/fvl.11.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Infections by measles virus and by HIV cause a state of immunodeficiency in the host. While measles virus leads to a transient immunodeficiency with depression of cellular mediated immunity, natural HIV infection leads to a progressive immunodeficiency of both humoral and cellular immunity. This review will focus on the interaction between HIV and measles virus in pediatric patients. Different scenarios of virus interaction will be dissected and their implications for a practical approach in terms of the individual patient and strategies to eliminate measles virus will be discussed.
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Affiliation(s)
- Maria Isabel de Moraes-Pinto
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Federal University of Sao Paulo, Rua Pedro de Toledo, 781, 9 andar, 04039–32 Sao Paulo SP, Brazil
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Machado AA, Machado CM, Boas LSV, Lopes MC, Gouvêa ADFB, Succi RCDM, Mendoza TRT, Kanashiro TM, Machado DM. Short communication: immunogenicity of an inactivated influenza vaccine and postvaccination influenza surveillance in HIV-infected and noninfected children and adolescents. AIDS Res Hum Retroviruses 2011; 27:999-1003. [PMID: 21284525 DOI: 10.1089/aid.2010.0306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Individuals infected with HIV are at higher risk for severe cases of seasonal influenza infection and should receive annual doses of vaccine. Our objectives were to evaluate the immunogenicity of an influenza vaccine in 37 HIV-infected patients (HIV group) compared to 29 uninfected individuals (control group) and to carry out a clinical and virological surveillance of influenza during a 6-month follow-up. Both groups received the vaccine recommended for the southern hemisphere in 2008. Antibody responses to antigens H1N1, H3N2, and B were measured in blood samples at vaccination (T0) and after 1 month (T1). Influenza surveillance was performed by weekly telephone calls for a follow-up period of 6 months. Nasal washes were taken from subjects with respiratory symptoms. The direct immunofluorescence assay in house polymerase chain reaction (PCR) and real-time PCR were used for the detection of different respiratory viruses. The median age of the participants was 13.3 years (sd = 2.2) and 12.1 years (sd = 1.3) for the HIV group and control group, respectively. One month after vaccination (T1), both groups showed significant increases in the antibody geometric mean titers (GMTs) for all antigens. However, healthy controls showed higher values for antigens A/H1N1 and A/H3N2 (p = 0.002 and 0.001, respectively). There was a higher increase in the percentage of HIV-uninfected subjects with protective A/H1N1 antibodies (96.6%) compared to HIV-infected vaccinees (67.6%) at T1 (p = 0.004). Rhinovirus (27.7%) and coronavirus (22.5%) were the most prevalent agents identified in HIV-infected individuals. In the control group, the viruses most frequently found were rhinovirus (24.2%) and adenovirus (21.2%). The seroprotection rate for the H1N1 antigen was higher in the control group, which also showed a greater increase in GMTs for H1N1 and H3N2 antigens after immunization. Viral agents were identified in 39/60 (65%) episodes of respiratory infections from the HIV-infected group and in 17/32 episodes (53.1%) from the control group (p = 0.273).
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14
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Miyamoto M, Ono E, Barbosa CPL, Terreri MTRA, Hilário MOE, Salomão R, Moraes-Pinto MID. Vaccine antibodies and T- and B-cell interaction in juvenile systemic lupus erythematosus. Lupus 2011; 20:736-44. [DOI: 10.1177/0961203310397409] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- M Miyamoto
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
| | - E Ono
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
| | - CPL Barbosa
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
| | - MTRA Terreri
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
| | - MOE Hilário
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
| | - R Salomão
- Division of Infectious Diseases, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - MI de Moraes-Pinto
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
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15
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Borges-Almeida E, Milanez HMBPM, Vilela MMS, Cunha FGP, Abramczuk BM, Reis-Alves SC, Metze K, Lorand-Metze I. The impact of maternal HIV infection on cord blood lymphocyte subsets and cytokine profile in exposed non-infected newborns. BMC Infect Dis 2011; 11:38. [PMID: 21291536 PMCID: PMC3040712 DOI: 10.1186/1471-2334-11-38] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Accepted: 02/03/2011] [Indexed: 02/08/2023] Open
Abstract
Background Children born to HIV+ mothers are exposed intra-utero to several drugs and cytokines that can modify the developing immune system, and influence the newborn's immune response to infections and vaccines. We analyzed the relation between the distribution of cord blood lymphocyte subsets and cytokine profile in term newborns of HIV+ mothers using HAART during pregnancy and compared them to normal newborns. Methods In a prospective, controlled study, 36 mother-child pairs from HIV+ mothers and 15 HIV-uninfected mothers were studied. Hematological features and cytokine profiles of mothers at 35 weeks of pregnancy were examined. Maternal and cord lymphocyte subsets as well as B-cell maturation in cord blood were analyzed by flow cytometry. The non-stimulated, as well as BCG- and PHA-stimulated production of IL2, IL4, IL7, IL10, IL12, IFN-γ and TNF-alpha in mononuclear cell cultures from mothers and infants were quantified using ELISA. Results After one year follow-up none of the exposed infants became seropositive for HIV. An increase in B lymphocytes, especially the CD19/CD5+ ones, was observed in cord blood of HIV-exposed newborns. Children of HIV+ hard drug using mothers had also an increase of immature B-cells. Cord blood mononuclear cells of HIV-exposed newborns produced less IL-4 and IL-7 and more IL-10 and IFN-γ in culture than those of uninfected mothers. Cytokine values in supernatants were similar in infants and their mothers except for IFN-γ and TNF-alpha that were higher in HIV+ mothers, especially in drug abusing ones. Cord blood CD19/CD5+ lymphocytes showed a positive correlation with cord IL-7 and IL-10. A higher maternal age and smoking was associated with a decrease of cord blood CD4+ cells. Conclusions in uninfected infants born to HIV+ women, several immunological abnormalities were found, related to the residual maternal immune changes induced by the HIV infection and those associated with antiretroviral treatment. Maternal smoking was associated to changes in cord CD3/CD4 lymphocytes and maternal hard drug abuse was associated with more pronounced changes in the cord B cell line.
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Affiliation(s)
- Eliane Borges-Almeida
- Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas, Rua Tessalia Vieira de Camargo 126, 13083-887 - Campinas, Brazil
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Sutcliffe CG, Moss WJ. Do children infected with HIV receiving HAART need to be revaccinated? THE LANCET. INFECTIOUS DISEASES 2010; 10:630-42. [DOI: 10.1016/s1473-3099(10)70116-x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Abzug MJ, Warshaw M, Rosenblatt HM, Levin MJ, Nachman SA, Pelton SI, Borkowsky W, Fenton T. Immunogenicity and immunologic memory after hepatitis B virus booster vaccination in HIV-infected children receiving highly active antiretroviral therapy. J Infect Dis 2009; 200:935-46. [PMID: 19663708 DOI: 10.1086/605448] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
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.
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Affiliation(s)
- Mark J Abzug
- University of Colorado Denver School of Medicine and The Children's Hospital, 13123 E. 16th Avenue, Aurora, CO 80045, USA.
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Ghosh S, Feyen O, Jebran AF, Huck K, Jetzek-Zader M, Bas M, Niehues T. Memory B cell function in HIV-infected children-decreased memory B cells despite ART. Pediatr Res 2009; 66:185-90. [PMID: 19390488 DOI: 10.1203/pdr.0b013e3181aa057d] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
B cell dysfunction is a well-studied complication of HIV infection in adults. Data on B cell differentiation in normal and HIV-infected children are lacking. We show the distribution of B cell subsets and immunoglobulin levels in HIV-infected children compared with controls. Furthermore, we observe the long-term B cell reconstitution of vaccine-specific immunity after antiretroviral therapy (ART). Phenotype of B cells (naive, non-switched memory, switched memory) was analyzed in 48 infected children and 62 controls. In nine HIV-infected children, functional reconstitution was quantified by tetanus-specific antibodies and by performing a lymphocyte transformation test (LTT) in a longitudinal approach. Switched memory B cells are significantly reduced in HIV-infected children. Vaccine-specific antibodies and response to LTT increase after initiation of ART. Our data indicate a significant dysfunction in the B cell system, despite effective ART. Partial reconstitution of humoral immunity may have therapeutic implications in a subset of HIV-infected children.
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Affiliation(s)
- Sujal Ghosh
- Department of Pediatric Oncology, Hematology and Clinical Immunology, University Hospital Düsseldorf, Düsseldorf, Germany
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Ono E, Nunes dos Santos AM, de Menezes Succi RC, Machado DM, de Angelis DSA, Salomão R, Kallás EG, de Moraes-Pinto MI. Imbalance of naive and memory T lymphocytes with sustained high cellular activation during the first year of life from uninfected children born to HIV-1-infected mothers on HAART. Braz J Med Biol Res 2009; 41:700-8. [PMID: 18797705 DOI: 10.1590/s0100-879x2008000800011] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Accepted: 08/04/2008] [Indexed: 11/22/2022] Open
Abstract
The immune consequences of in utero HIV exposure to uninfected children whose mothers were submitted to highly active antiretroviral therapy (HAART) during gestation are not well defined. We evaluated 45 HIV-exposed uninfected (ENI) neonates and 45 healthy unexposed control (CT) neonates. All HIV-infected mothers received HAART during pregnancy, and the viral load at delivery was <50 copies/mL for 56.8%. Twenty-three ENI neonates were further evaluated after 12 months and compared to 23 unexposed healthy age-matched infants. Immunophenotyping was performed by flow cytometry in cord and peripheral blood. Cord blood lymphocyte numbers did not differ between groups. However, ENI neonates had a lower percentage of naive T cells than CT neonates (CD4+, 76.6 vs 83.1%, P < 0.001; CD8+, 70.9 vs 79.6%, P = 0.003) and higher percentages of central memory T cells than CT neonates (CD4+, 13.9 vs 8.7%, P < 0.001; CD8+, 8.6 vs 4.8%, P = 0.001). CD38 mean fluorescence intensity of T cells was higher in ENI neonates (CD4+, 62.2 vs 52.1, P = 0.007; CD8+, 47.7 vs 35.3, P < 0.001). At 12 months, ENI infants still had higher mean fluorescence intensity of CD38 on T cells (CD4+, 34.2 vs 23.3, P < 0.001; CD8+, 26.8 vs 19.4, P = 0.035). Despite effective maternal virologic control at delivery, HIV-exposed uninfected children were born with lower levels of naive T cells. Immune activation was present at birth and remained until at least 12 months of age, suggesting that in utero exposure to HIV causes subtle immune abnormalities.
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Affiliation(s)
- E Ono
- Disciplina de Infectologia Pediátrica, Universidade Federal de São Paulo
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20
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Ramduth D, Thobakgale CF, Mkhwanazi NP, De Pierres C, Reddy S, van der Stok M, Mncube Z, Mphatswe W, Blanckenberg N, Cengimbo A, Prendergast A, Tudor-Williams G, Dong K, Jeena P, Coovadia HM, Day CL, Kiepiela P, Goulder PJ, Walker BD. Detection of HIV type 1 gag-specific CD4(+) T cell responses in acutely infected infants. AIDS Res Hum Retroviruses 2008; 24:265-70. [PMID: 18284325 DOI: 10.1089/aid.2007.0096] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Multiple HIV-1-specific cytokine and proliferative responses by CD4(+) T cells have not been studied in acutely infected infants. Using an intracellular cytokine staining assay, 34 untreated clade C HIV-1-infected infants (2-102 days old) were assessed for IFN-gamma, 28/34 for IL-2, and 26/34 for TNF-alpha responses to all HIV-1 proteins. Responses were detected in 29%, 36%, and 15% of infants, respectively. Twelve of the original 34 infants were then studied longitudinally for 14 months to determine the effect of viral load on IFN-gamma Gag-specific responses: seven infants were treated for 1 year, stopped treatment, and resumed when CD4% was < 20 and five infants were treated only when the CD4% was <20. Following treatment cessation, there was an immediate increase in viral load followed by an increase in the magnitude of CD4(+) Gag-specific responses. Despite this, the majority of infants (54%) had to restart treatment by 24 months of age, indicating that the immune responses were antigen driven but not associated with protection. Among untreated infants HIV-specific CD4(+) responses were detected sporadically indicating a dysfunctional immune response in the face of constant exposure to high levels of viremia.
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Affiliation(s)
- Danni Ramduth
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, 4013 Durban, South Africa
| | - Christina F. Thobakgale
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, 4013 Durban, South Africa
| | - Nompumelelo P. Mkhwanazi
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, 4013 Durban, South Africa
| | - Chantal De Pierres
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, 4013 Durban, South Africa
| | - Sharon Reddy
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, 4013 Durban, South Africa
| | - Mary van der Stok
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, 4013 Durban, South Africa
| | - Zenele Mncube
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, 4013 Durban, South Africa
| | - Wendy Mphatswe
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, 4013 Durban, South Africa
| | - Natasha Blanckenberg
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, 4013 Durban, South Africa
| | - Ayanda Cengimbo
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, 4013 Durban, South Africa
| | - Andrew Prendergast
- Department of Pediatrics, Nuffield Department of Medicine, The Peter Medawar Building for Pathogen Research, Oxford University, Oxford OX1 3SY, United Kingdom
| | - Gareth Tudor-Williams
- Department of Pediatrics, Nuffield Department of Medicine, The Peter Medawar Building for Pathogen Research, Oxford University, Oxford OX1 3SY, United Kingdom
| | - Krista Dong
- Infectious Diseases, Massachetts General Hospital, Boston, Massachusetts
| | - Prakash Jeena
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, 4013 Durban, South Africa
| | - Hoosen M. Coovadia
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, 4013 Durban, South Africa
| | - Cheryl L. Day
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, 4013 Durban, South Africa
- Infectious Diseases, Massachetts General Hospital, Boston, Massachusetts
| | - Photini Kiepiela
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, 4013 Durban, South Africa
| | - Philip J.R. Goulder
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, 4013 Durban, South Africa
- Department of Pediatrics, Nuffield Department of Medicine, The Peter Medawar Building for Pathogen Research, Oxford University, Oxford OX1 3SY, United Kingdom
- Infectious Diseases, Massachetts General Hospital, Boston, Massachusetts
| | - Bruce D. Walker
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, 4013 Durban, South Africa
- Infectious Diseases, Massachetts General Hospital, Boston, Massachusetts
- Howard Hughes Medical Institute, Chevy Chase, Maryland
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Tárnok A, Bocsi J, Lenz D, Janousek J. Protein Losing Enteropathy after Fontan Surgery – Clinical and Diagnostical Aspects. Transfus Med Hemother 2007. [DOI: 10.1159/000101373] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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