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Sainz T, Casas I, González-Esguevillas M, Escosa-Garcia L, Muñoz-Fernández MÁ, Prieto L, Gosalbes MJ, Jiménez-Hernández N, Ramos JT, Navarro ML, Mellado MJ, Serrano-Villar S, Calvo C. Nutritional Supplementation to Increase Influenza Vaccine Response in Children Living With HIV: A Pilot Clinical Trial. Front Pediatr 2022; 10:919753. [PMID: 35928688 PMCID: PMC9343631 DOI: 10.3389/fped.2022.919753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Vaccine response is poor among children living with HIV. The gut microbiota has been identified as a potential target to improve vaccine immunogenicity, but data are scarce in the context of HIV infection. METHODS Pilot, double-blind, randomized placebo-controlled trial in which 24 HIV-infected children were randomized to receive a mixture of symbiotics, omega-3/6 fatty acids, and amino acids or placebo for 4 weeks, each in combination with ART, and were then immunized against influenza. Vaccine response and safety of the nutritional supplementation were the primary outcomes. RESULTS Eighteen HIV-infected children completed the follow-up period (mean age 11.5 ± 4.14 years, 61% female). The nutritional supplement was safe but did not enhance the response to the influenza vaccine. A 4-fold rise in antibody titers was obtained in only 37.5% of participants in the intervention arm vs. 40% in the placebo. No immunological or inflammatory predictors of vaccine response were identified. CONCLUSIONS In this exploratory study, a 4-week course of symbiotics did not increase influenza vaccine immunogenicity in HIV-infected children. Larger studies are warranted to address the potential of modulating the microbiome in children living with HIV.
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Affiliation(s)
- Talía Sainz
- Servicio de Pediatría, Hospital Universitario La Paz and IdiPAZ, Madrid, Spain.,Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Madrid, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Inmaculada Casas
- Respiratory Virus and Influenza Unit, Instituto de Salud Carlos III, Madrid, Spain.,Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Luis Escosa-Garcia
- Servicio de Pediatría, Hospital Universitario La Paz and IdiPAZ, Madrid, Spain.,Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Madrid, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - María Ángeles Muñoz-Fernández
- Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Madrid, Spain.,Laboratorio de InmunoBiología Molecular Hospital General Universitario Gregorio Marañón e IISHGM, Madrid, Spain
| | - Luis Prieto
- Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Madrid, Spain.,Hospital 12 de Octubre, Madrid, Spain.,Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - María José Gosalbes
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Área Genómica y Salud, Fundación Para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), Valencia, Spain
| | - Nuria Jiménez-Hernández
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Área Genómica y Salud, Fundación Para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), Valencia, Spain
| | - José Tomas Ramos
- Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Madrid, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.,Universidad Complutense de Madrid (UCM), Madrid, Spain.,Servicio de Pediatría, Hospital Clinico San Carlos and IdISSC, Madrid, Spain
| | - María Luisa Navarro
- Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Madrid, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.,Universidad Complutense de Madrid (UCM), Madrid, Spain.,Unidad de Investigación Materno-Infantil Familia Alonso (UDIMIFFA), IISGM, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón e IISHGM, Madrid, Spain
| | - María José Mellado
- Servicio de Pediatría, Hospital Universitario La Paz and IdiPAZ, Madrid, Spain.,Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Madrid, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Sergio Serrano-Villar
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.,Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, and IRYCIS, Madrid, Spain
| | - Cristina Calvo
- Servicio de Pediatría, Hospital Universitario La Paz and IdiPAZ, Madrid, Spain.,Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Madrid, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Lau YF, Tang LH, Chien Lye D, Ooi EE, Leo YS. Serological response to trivalent inactivated influenza vaccine in HIV-infected adults in Singapore. Hum Vaccin Immunother 2017; 13:551-560. [PMID: 28277090 DOI: 10.1080/21645515.2016.1246636] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
A cohort of 81 HIV-infected participants received seasonal trivalent inactivated influenza vaccine (TIV) and their humoral responses were monitored using hemagglutination inhibition (HAI) assay and enzyme-linked immunosorbent assay (ELISA). Three weeks after the vaccination, the percentage of the cohort that had an HAI titer of >1:40 was 35% (for H1N1), 43% (for H3N2) and 19% (for influenza B). An increase in HAI titer can be achieved by an increase in magnitude of the antibody responses, which can be measured by an increase in ELISA titer; as well as a quality improvement of the antibody responses through increased avidity to the virus. For some individuals, an increase in avidity alone is sufficient to reach the sero-protective titer. Notably, a number of volunteers showed an increase in ELISA titer without a rise in HAI titer. A total of 24 participants (30%) did not show any significant increase in both HAI and ELISA tests after vaccination. Apart from a lower peripheral CD4+ T cell count, the non responders' peripheral blood mononuclear cells (PBMC) also had a higher IL-10 mRNA expression after TIV vaccination ex vivo. Cytokine profiling demonstrated that, apart from a weaker MCP-1 expression in the non-responder group, PBMC from both groups responded comparably to lipopolysaccharide (LPS) stimulation in vitro. Since only 3 participants developed sero-protective titers against all 3 subtypes after vaccination, our study highlights a need to enhance the immunogenicity of the subunit vaccine for this population, potentially through harnessing the innate immunity with an external adjuvant.
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Affiliation(s)
- Yuk-Fai Lau
- a Host-pathogen Interactions Laboratory, DMERI , DSO National Laboratories , The Republic of Singapore.,b Program in Emerging Infectious Diseases , Duke-NUS Medical School , The Republic of Singapore
| | - Lay-Hoon Tang
- a Host-pathogen Interactions Laboratory, DMERI , DSO National Laboratories , The Republic of Singapore
| | - David Chien Lye
- c Communicable Disease Centre , Tan Tock Seng Hospital , Singapore.,d Yong Loo Lin School of Medicine , National University of Singapore , Singapore
| | - Eng-Eong Ooi
- b Program in Emerging Infectious Diseases , Duke-NUS Medical School , The Republic of Singapore
| | - Yee-Sin Leo
- c Communicable Disease Centre , Tan Tock Seng Hospital , Singapore.,d Yong Loo Lin School of Medicine , National University of Singapore , Singapore.,e Saw Swee Hock School of Public Health , National University of Singapore , Singapore
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Efficacy and immunogenicity of influenza vaccine in HIV-infected children: a randomized, double-blind, placebo controlled trial. AIDS 2013; 27:369-79. [PMID: 23032417 DOI: 10.1097/qad.0b013e32835ab5b2] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND HIV-infected children are at heightened risk for severe influenza illness; however, there is no study on the efficacy or effectiveness of influenza vaccine in these children. We evaluated the safety, immunogenicity, and efficacy of nonadjuvanted, trivalent inactivated influenza vaccine (TIV) against confirmed seasonal influenza virus illness in HIV-infected children. METHODS A double-blind, placebo-controlled trial was undertaken in Johannesburg in 2009. Four hundred and ten children were randomized to two doses of TIV or placebo 1 month apart. Nasopharyngeal aspirates obtained at respiratory illness visits were tested by influenza-specific reverse transcriptase-PCR (RT-PCR). Vaccine immunogenicity was evaluated by hemagglutinin inhibition (HAI) assay. Influenza isolates were sequenced and evaluated in maximum likelihood phylogenetic analysis. RESULTS Overall, the median age of participants was 23.8 months and their median CD4% was 33.5. Ninety-two percent of enrolees were on antiretroviral therapy. Among children receiving both doses of vaccine/placebo, confirmed seasonal influenza illness occurred in 13 (all H3N2) of 205 TIV recipients and 17 (15 H3N2 and two influenza B) of 200 placebo recipients with vaccine efficacy of 17.7% (95% confidence interval <0-62.4%). The proportion of TIV recipients who seroconverted after second dose against vaccine strains of H1N1, H3N2, and influenza B were 47.5, 50.0, and 40.0%, compared to 4.7, 11.6, and 0%, respectively among placebo recipients. There were no TIV-related serious adverse events. Sequence analysis of wild-type H3N2 strains indicated drift from the H3N2 vaccine strain. CONCLUSION Poor immunogenicity of TIV, coupled with drift of circulating H3N2 wild-type compared to vaccine strain, may explain the lack of efficacy of TIV in young HIV-infected children. Alternate TIV vaccine schedules or formulations warrant evaluation for efficacy in HIV-infected children.
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Long-term immunogenicity after one and two doses of a monovalent MF59-adjuvanted A/H1N1 Influenza virus vaccine coadministered with the seasonal 2009-2010 nonadjuvanted Influenza virus vaccine in HIV-infected children, adolescents, and young adults in a randomized controlled trial. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2011; 18:1503-9. [PMID: 21795458 DOI: 10.1128/cvi.05200-11] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Few data are available on the safety and long-term immunogenicity of A/H1N1 pandemic influenza vaccines for HIV-infected pediatric patients. We performed a randomized controlled trial to evaluate the safety and long-term immunogenicity of 1 versus 2 doses of the 2009 monovalent pandemic influenza A/H1N1 MF59-adjuvanted vaccine (PV) coadministered with the seasonal 2009-2010 trivalent nonadjuvanted influenza vaccine (SV) to HIV-infected children, adolescents, and young adults. A total of 66 HIV-infected patients aged 9 to 26 years were randomized to receive one (group 1) or two (group 2) doses of PV coadministered with 1 dose of SV. The main outcome was the seroconversion rate for PV at 1 month. Secondary outcomes were the geometric mean titer ratios and the seroprotection rates at 1 month for all vaccines, seroconversion rates at 1 month for SV, and longitudinal changes of antibody titers (ABTs) at 1, 2, 6, and 12 months for all vaccines. Groups 1 and 2 had similar CD4 counts and HIV RNA levels during the study. The seroconversion rate for PV was 100% at 1 month in both groups. ABTs for PV were high during the first 6 months and declined below seroprotection levels thereafter. Longitudinal changes in ABTs were similar in groups 1 and 2 for both PV and SV. The side effects of vaccination were mild and mostly local. In HIV-infected children, adolescents, and young adults, the immune response triggered by a single dose of PV was similar to that obtained with a double dose and was associated with long-term antibody response.
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