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Faustini SE, Hodson J, Birtwistle J, Whitelegg A, Masuka S, Singo M, Chigiga J, Shields A, Plant T, Drayson MT, Manavi K, MacLennan CA, Richter A. Comparison of short- and long-term humoral immune responses to pneumococcal polysaccharide and glycoconjugate vaccines in an HIV-infected population. J Infect 2024:106282. [PMID: 39326516 DOI: 10.1016/j.jinf.2024.106282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 09/17/2024] [Accepted: 09/18/2024] [Indexed: 09/28/2024]
Abstract
BACKGROUND Immunization is recommended internationally to protect against pneumococcal infections in HIV-infected adults. However, vaccination schedule designs are mostly based on studies of initial rather than long-term antibody responses. This UK observational study investigated the short- and long-term antibody responses to polysaccharide and glycoconjugate pneumococcal vaccines in an adult HIV-infected cohort. METHODS We studied a subgroup of 152 of 839 participants from the AIR (Assessment of Immune Responses to Routine Immunisations in HIV-infected Adults, ISRCTN95588307) study, that had received pneumococcal vaccinations, and had blood samples collected pre- and post-vaccination, as well as at least annually for four subsequent calendar years. Patients received either Pneumovax-23 (PPV, N=89) or Prevenar-13 (PCV, N=63) as their primary vaccine, with immunity assessed by measuring IgG antibody concentrations for 12 pneumococcal polysaccharide serotypes (PnPS). The primary outcome was achieving IgG antibody concentrations above the recommended World Health Organisation (WHO) threshold of 0.35µg/ml for at least 8/12 of the PnPS assessed (WHO≥8/12PnPS). Patients who did not achieve WHO≥8/12PnPS after the primary vaccination were offered further vaccination with PCV; booster vaccinations with PCV were additionally offered to those where antibody levels subsequently fell below the WHO≥8/12PnPS threshold. RESULTS Patients receiving PCV as their primary pneumococcal vaccine were significantly more likely to achieve WHO≥8/12PnPS after a single vaccine dose than those receiving PPV (54% vs. 33%, p=0.012). This difference persisted following booster vaccination with PCV, with cumulative rates of WHO≥8/12PnPS in those receiving PCV vs. PPV as the primary vaccine of 88% vs. 67% and 100% vs. 85% after receiving up to one and two booster vaccinations, respectively. Where WHO≥8/12PnPS was achieved, this persisted significantly longer in those receiving PCV as their primary vaccine compared to PPV (median: 23.5 vs. 11.1 months; p=0.010). CONCLUSIONS Immunization with PCV resulted in quantitatively greater antibody responses than immunization with PPV in a cohort of HIV-infected UK adults. Individuals receiving PCV as their primary vaccine required fewer total pneumococcal vaccine doses to achieve WHO≥8/12PnPS and experienced greater duration of time above this threshold than those with PPV as the primary vaccine. However, the median longevity of both vaccine responses was relatively short, which supports the use of ongoing booster doses using high valency glycoconjugate vaccines to sustain WHO≥8/12PnPS threshold antibody levels.
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Affiliation(s)
- Siân E Faustini
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, England, UK.
| | - James Hodson
- Research Development and Innovation, Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, England, UK
| | - Jane Birtwistle
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, England, UK
| | - Alison Whitelegg
- University Hospital Southampton NHS Foundation Trust, Southampton, England, UK
| | - Sindiso Masuka
- HIV Services, Queen Elizabeth Hospital Birmingham, Birmingham, England, UK
| | - Mebie Singo
- HIV Services, Queen Elizabeth Hospital Birmingham, Birmingham, England, UK
| | - Joyful Chigiga
- HIV Services, Queen Elizabeth Hospital Birmingham, Birmingham, England, UK
| | - Adrian Shields
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, England, UK
| | - Timothy Plant
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, England, UK
| | - Mark T Drayson
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, England, UK
| | - Kaveh Manavi
- HIV Services, Queen Elizabeth Hospital Birmingham, Birmingham, England, UK
| | - Calman A MacLennan
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, England, UK; Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Alex Richter
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, England, UK.
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Tortellini E, Fosso Ngangue YC, Dominelli F, Guardiani M, Falvino C, Mengoni F, Carraro A, Marocco R, Pasculli P, Mastroianni CM, Ciardi MR, Lichtner M, Zingaropoli MA. Immunogenicity and Efficacy of Vaccination in People Living with Human Immunodeficiency Virus. Viruses 2023; 15:1844. [PMID: 37766251 PMCID: PMC10534440 DOI: 10.3390/v15091844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
People living with HIV (PLWH) remain at high risk of mortality and morbidity from vaccine-preventable diseases, even though antiretroviral therapy (ART) has restored life expectancy and general well-being. When, which, and how many doses of vaccine should be administered over the lifetime of PLWH are questions that have become clinically relevant. Immune responses to most vaccines are known to be impaired in PLWH. Effective control of viremia with ART and restored CD4+ T-cell count are correlated with an improvement in responsiveness to routine vaccines. However, the presence of immune alterations, comorbidities and co-infections may alter it. In this article, we provide a comprehensive review of the literature on immune responses to different vaccines in the setting of HIV infection, emphasizing the potential effect of HIV-related factors and presence of comorbidities in modulating such responses. A better understanding of these issues will help guide vaccination and prevention strategies for PLWH.
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Affiliation(s)
- Eeva Tortellini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Yann Collins Fosso Ngangue
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Federica Dominelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Mariasilvia Guardiani
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Carmen Falvino
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Fabio Mengoni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Anna Carraro
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Raffaella Marocco
- Infectious Diseases Unit, SM Goretti Hospital, Sapienza University of Rome, 00185 Latina, Italy; (R.M.); (M.L.)
| | - Patrizia Pasculli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Claudio Maria Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Maria Rosa Ciardi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Miriam Lichtner
- Infectious Diseases Unit, SM Goretti Hospital, Sapienza University of Rome, 00185 Latina, Italy; (R.M.); (M.L.)
- Department of Neurosciences, Mental Health, and Sense Organs, NESMOS, Sapienza University of Rome, 00185 Rome, Italy
| | - Maria Antonella Zingaropoli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
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Righi E, Gallo T, Azzini AM, Mazzaferri F, Cordioli M, Merighi M, Tacconelli E. A Review of Vaccinations in Adult Patients with Secondary Immunodeficiency. Infect Dis Ther 2021; 10:637-661. [PMID: 33687662 PMCID: PMC7941364 DOI: 10.1007/s40121-021-00404-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 01/20/2021] [Indexed: 12/29/2022] Open
Abstract
Vaccine-preventable diseases and their related complications are associated with increased morbidity and mortality in patients with altered immunocompetence. Optimised immunisation in this patient population is challenging because of limited data from vaccine trials, suboptimal vaccine efficacy and safety concerns. Reliable efficacy data are lacking among patients with altered immunocompetence, and existing recommendations are mainly based on expert consensus and may vary geographically. Inactivated vaccines can be generally used without risks in this group, but their efficacy may be reduced, and immunisation schedules vary according to local guidelines, age, and type and stage of the underlying disease. Live vaccines, if indicated, should be administered with care because of the risk of vaccine-associated disease. We have reviewed the current evidence on vaccination principles and recommendations in adult patients with secondary immunodeficiencies, including asplenia, HIV infection, stem cell and solid organ transplant, haematological malignancies, inflammatory bowel disease and other chronic disorders.
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Affiliation(s)
- Elda Righi
- Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
- Infectious Diseases, Verona University Hospital, Verona, Italy.
| | - Tolinda Gallo
- Public Health Department, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Anna Maria Azzini
- Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
- Infectious Diseases, Verona University Hospital, Verona, Italy
| | | | - Maddalena Cordioli
- Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
- Infectious Diseases, Verona University Hospital, Verona, Italy
| | - Mara Merighi
- Infectious Diseases, Verona University Hospital, Verona, Italy
| | - Evelina Tacconelli
- Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
- Infectious Diseases, Verona University Hospital, Verona, Italy
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Driciru E, Koopman JPR, Cose S, Siddiqui AA, Yazdanbakhsh M, Elliott AM, Roestenberg M. Immunological Considerations for Schistosoma Vaccine Development: Transitioning to Endemic Settings. Front Immunol 2021; 12:635985. [PMID: 33746974 PMCID: PMC7970007 DOI: 10.3389/fimmu.2021.635985] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/11/2021] [Indexed: 12/16/2022] Open
Abstract
Despite mass drug administration programmes with praziquantel, the prevalence of schistosomiasis remains high. A vaccine is urgently needed to control transmission of this debilitating disease. As some promising schistosomiasis vaccine candidates are moving through pre-clinical and clinical testing, we review the immunological challenges that these vaccine candidates may encounter in transitioning through the clinical trial phases in endemic settings. Prior exposure of the target population to schistosomes and other infections may impact vaccine response and efficacy and therefore requires considerable attention. Schistosomes are known for their potential to induce T-reg/IL-10 mediated immune suppression in populations which are chronically infected. Moreover, endemicity of schistosomiasis is focal whereby target and trial populations may exhibit several degrees of prior exposure as well as in utero exposure which may increase heterogeneity of vaccine responses. The age dependent distribution of exposure and development of acquired immunity, and general differences in the baseline immunological profile, adds to the complexity of selecting suitable trial populations. Similarly, prior or concurrent infections with other parasitic helminths, viral and bacterial infections, may alter immunological responses. Consequently, treatment of co-infections may benefit the immunogenicity of vaccines and may be considered despite logistical challenges. On the other hand, viral infections leave a life-long immunological imprint on the human host. Screening for serostatus may be needed to facilitate interpretation of vaccine responses. Co-delivery of schistosome vaccines with PZQ is attractive from a perspective of implementation but may complicate the immunogenicity of schistosomiasis vaccines. Several studies have reported PZQ treatment to induce both transient and long-term immuno-modulatory effects as a result of tegument destruction, worm killing and subsequent exposure of worm antigens to the host immune system. These in turn may augment or antagonize vaccine immunogenicity. Understanding the complex immunological interactions between vaccine, co-infections or prior exposure is essential in early stages of clinical development to facilitate phase 3 clinical trial design and implementation policies. Besides well-designed studies in different target populations using schistosome candidate vaccines or other vaccines as models, controlled human infections could also help identify markers of immune protection in populations with different disease and immunological backgrounds.
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Affiliation(s)
- Emmanuella Driciru
- Immunomodulation and Vaccines Programme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | | | - Stephen Cose
- Immunomodulation and Vaccines Programme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Afzal A. Siddiqui
- Center for Tropical Medicine and Infectious Diseases, Texas Tech University School of Medicine, Lubbock, TX, United States
- Department of Internal Medicine, Center for Tropical Medicine and Infectious Diseases, Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Maria Yazdanbakhsh
- Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
| | - Alison M. Elliott
- Immunomodulation and Vaccines Programme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Meta Roestenberg
- Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
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5
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Ho A, Aston SJ, Jary H, Mitchell T, Alaerts M, Menyere M, Mallewa J, Nyirenda M, Everett D, Heyderman RS, French N. Impact of Human Immunodeficiency Virus on the Burden and Severity of Influenza Illness in Malawian Adults: A Prospective Cohort and Parallel Case-Control Study. Clin Infect Dis 2019; 66:865-876. [PMID: 29045699 PMCID: PMC5850564 DOI: 10.1093/cid/cix903] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 10/14/2017] [Indexed: 02/06/2023] Open
Abstract
Background The impact of human immunodeficiency virus (HIV) infection on influenza incidence and severity in adults in sub-Saharan Africa is unclear. Seasonal influenza vaccination is recommended for HIV-infected persons in developed settings but is rarely implemented in Africa. Methods We conducted a prospective cohort study to compare the incidence of laboratory-confirmed influenza illness between HIV-infected and HIV-uninfected adults in Blantyre, Malawi. In a parallel case-control study, we explored risk factors for severe influenza presentation of severe (hospitalized) lower respiratory tract infection, and mild influenza (influenza-like illness [ILI]). Results The cohort study enrolled 608 adults, of whom 360 (59%) were HIV infected. Between April 2013 and March 2015, 24 of 229 ILI episodes (10.5%) in HIV-infected and 5 of 119 (4.2%) in HIV-uninfected adults were positive for influenza by means of polymerase chain reaction (incidence rate, 46.0 vs 14.5 per 1000 person-years; incidence rate ratio, 2.75; 95% confidence interval, 1.02-7.44; P = .03; adjusted for age, sex, household crowding, and food security). In the case-control study, influenza was identified in 56 of 518 patients (10.8%) with hospitalized lower respiratory tract infection, and 88 or 642 (13.7%) with ILI. The HIV prevalence was 69.6% and 29.6%, respectively, among influenza-positive case patients and controls. HIV was a significant risk factor for severe influenza (odds ratio, 4.98; 95% confidence interval, 2.09-11.88; P < .001; population-attributable fraction, 57%; adjusted for season, sanitation facility, and food security). Conclusions HIV is an important risk factor for influenza-associated ILI and severe presentation in this high-HIV prevalence African setting. Targeted influenza vaccination of HIV-infected African adults should be reevaluated, and the optimal mechanism for vaccine introduction in overstretched health systems needs to be determined.
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Affiliation(s)
- Antonia Ho
- Institute of Infection and Global Health, University of Liverpool, United Kingdom.,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Stephen J Aston
- Institute of Infection and Global Health, University of Liverpool, United Kingdom.,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Hannah Jary
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,Liverpool School of Tropical of Medicine, United Kingdom
| | - Tamara Mitchell
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Maaike Alaerts
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Mavis Menyere
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Jane Mallewa
- Queen Elizabeth Central Hospital, Blantyre, Malawi.,College of Medicine, University of Malawi, Blantyre, Malawi
| | - Mulinda Nyirenda
- Queen Elizabeth Central Hospital, Blantyre, Malawi.,College of Medicine, University of Malawi, Blantyre, Malawi
| | - Dean Everett
- Institute of Infection and Global Health, University of Liverpool, United Kingdom.,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Robert S Heyderman
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,University College London, United Kingdom
| | - Neil French
- Institute of Infection and Global Health, University of Liverpool, United Kingdom.,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
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Santagostino E, Riva A, Cesaro S, Esposito S, Matino D, Mazzucchelli RI, Molinari AC, Mura R, Notarangelo LD, Tagliaferri A, Di Minno G, Clerici M. Consensus statements on vaccination in patients with haemophilia-Results from the Italian haemophilia and vaccinations (HEVA) project. Haemophilia 2019; 25:656-667. [PMID: 30990961 PMCID: PMC6850056 DOI: 10.1111/hae.13756] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 03/15/2019] [Accepted: 03/15/2019] [Indexed: 12/13/2022]
Abstract
Vaccination against communicable diseases is crucial for disease prevention, but this practice poses challenges to healthcare professionals in patients with haemophilia. Poor knowledge of the vaccination requirements for these patients and safety concerns often result in vaccination delay or avoidance. In order to address this issue, a panel of 11 Italian haemophilia and immunization experts conducted a Delphi consensus process to identify the main concerns regarding the safe use of vaccines in patients with haemophilia. The consensus was based on a literature search of the available evidence, which was used by the experts to design 27 consensus statements. A group of clinicians then rated these statements using the 5-point Likert-type scale (1 = strongly disagree; 5 = strongly agree). The main issues identified by the expert panel included vaccination schedule for haemophilic patients; protocol and optimal route of vaccine administration; vaccination of haemophilic patients with antibodies inhibiting coagulation factor VIII (inhibitors); and vaccination and risk of inhibitor development. This manuscript discusses these controversial areas in detail supported by the available literature evidence and provides evidence- and consensus-based recommendations. Overall, participants agreed on most statements, except those addressing the potential role of vaccination in inhibitor formation. Participants agreed that patients with haemophilia should receive vaccinations according to the institutional schedule for individuals without bleeding disorders; however, vaccination of patients with haemophilia requires comprehensive planning, taking into account disease severity, type and route of vaccination, and bleeding risk. Data also suggest vaccination timing does not need to take into consideration when the patient received factor VIII replacement.
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Affiliation(s)
- Elena Santagostino
- Fondazione IRCCS Ca’ Granda, Ospedale Maggiore PoliclinicoCentro Emofilia e Trombosi Angelo Bianchi BonomiMilanItaly
| | - Agostino Riva
- III Divisione di Malattie InfettiveOspedale L. Sacco ‐ Polo UniversitarioMilanItaly
| | - Simone Cesaro
- Pediatric Hematology OncologyAzienda Ospedaliera Universitaria IntegrataVeronaItaly
| | - Susanna Esposito
- Department of Surgical and Biomedical Sciences Pediatric ClinicUniversità degli Studi di PerugiaPerugiaItaly
| | - Davide Matino
- Department of Experimental MedicineUniversità degli Studi di PerugiaPerugiaItaly
| | | | | | - Rosamaria Mura
- Pediatric Hematology and Oncology UnitOspedale Pediatrico MicrocitemicoCagliariItaly
| | | | - Annarita Tagliaferri
- Regional Reference Center for Inherited Bleeding DisordersUniversity Hospital of ParmaParmaItaly
| | - Giovanni Di Minno
- Regional Reference Center for Coagulation DisordersFederico II University HospitalNaplesItaly
| | - Mario Clerici
- Department of Pathophysiology and TransplantationUniversità degli Studi di MilanoMilanItaly
- Don C Gnocchi Foundation IRCCSMilanItaly
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7
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Hepatitis B Vaccination Induced TNF- α- and IL-2-Producing T Cell Responses in HIV- Healthy Individuals Higher than in HIV+ Individuals Who Received the Same Vaccination Regimen. J Immunol Res 2018; 2018:8350862. [PMID: 29682590 PMCID: PMC5848135 DOI: 10.1155/2018/8350862] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 12/28/2017] [Indexed: 12/15/2022] Open
Abstract
We investigated cytokine production and expression of degranulation marker CD107a after different strategies of hepatitis B virus (HBV) vaccination in human immunodeficiency virus-infected individuals, which were three doses of 20 μg (standard dose group), four doses of 20 μg (four doses group), or four doses of 40 μg (four double doses group), compared to standard dose vaccination in healthy controls. PBMCs collected at different time points were stimulated in vitro with recombinant hepatitis B surface antigen and analyzed by flow cytometry. There was an increase in TNF-α production of total and memory CD4+ T cells at 7 months after vaccination in healthy controls compared to the HIV+ group, which received the same standard vaccination regimen. An increase in the IL-2-producing memory CD4+ T cells in the healthy control group was also observed at 7 months after vaccination. No differences were observed between the healthy controls and both groups of four doses at any time point of study. These results suggest that the standard HBV vaccination schedule might induce better production of TNF-α and IL-2 from CD4+ T cells in healthy individuals. Modification of HBV vaccination schedule by increasing the frequency and/or dosage may improve the CMI response in HIV-infected individuals. This trial is registered with NCT1289106.
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8
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Molloy A, Curtis H, Burns F, Freedman A. Routine monitoring and assessment of adults living with HIV: results of the British HIV Association (BHIVA) national audit 2015. BMC Infect Dis 2017; 17:619. [PMID: 28903730 PMCID: PMC5598005 DOI: 10.1186/s12879-017-2708-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 08/28/2017] [Indexed: 02/06/2023] Open
Abstract
Background The clinical care of people living with HIV changed fundamentally as a result of the development of effective antiretroviral therapy (ART). HIV infection is now a long-term treatable condition. We report a national audit to assess adherence to British HIV Association guidelines for the routine investigation and monitoring of adult HIV-1-infected individuals. Methods All UK sites known as providers of adult HIV outpatient services were invited to complete a case-note review and a brief survey of local clinic practices. Participating sites were asked to randomly select 50–100 adults, who attended for specialist HIV care during 2014 and/or 2015. Each site collected data electronically using a self-audit spreadsheet tool. This included demographic details (gender, ethnicity, HIV exposure, and age) and whether 22 standardised and pre-defined clinical audited outcomes had been recorded. Results Data were collected on 8258 adults from 123 sites, representing approximately 10% of people living with HIV reported in public health surveillance as attending UK HIV services. Sexual health screening was provided within 96.4% of HIV services, cervical cytology and influenza vaccination within 71.4% of HIV services. There was wide variation in resistance testing across sites. Only 44.9% of patients on ART had a documented 10-year CVD risk within the past three years and fracture risk had been assessed within the past three years for only 16.7% patients aged over 50 years. Conclusions There was high participation in the national audit and good practice was identified in some areas. However improvements can be made in monitoring of cardiovascular risk, bone and sexual health.
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Affiliation(s)
- A Molloy
- Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, United Kingdom.
| | - H Curtis
- British HIV Association, c/o Mediscript Ltd, 1 Mountview Court, 310 Friern Barnet Lane, London, N20 0LD, United Kingdom
| | - F Burns
- Royal Free London NHS Foundation Trust AND Research Department of Infection & Population Health, University College London, Pond Street, London, NW3 2QG, United Kingdom
| | - A Freedman
- British HIV Association AND Clinical Reader in Infectious Diseases and Honorary consultant Physician in General Medicine & Infectious Diseases at University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, United Kingdom
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Persistence of Hepatitis B Immunity Following 3-dose Infant Primary Series in HIV-infected Thai Adolescents and Immunologic Response to Revaccination. Pediatr Infect Dis J 2017; 36:863-868. [PMID: 28419007 DOI: 10.1097/inf.0000000000001613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND HIV infection may alter immunologic response and the establishment of immune memory to infant hepatitis B virus (HBV) vaccination. This study aimed to determine the need to revaccinate perinatally HIV-infected Thai adolescents. METHODS Cross-sectional serologic tests for HBV, including hepatitis B surface antigen, anti-hepatitis B surface antibody (anti-HBs) and anti-hepatitis B core antibody (anti-HBc), were performed in perinatally HIV-infected adolescents. Adolescents having anti-HBs <100 mIU/mL with negative anti-HBc and immune reconstitution from highly active antiretroviral therapy (HAART) were revaccinated using regular (10 μg) 3-dose schedule given intramuscularly at 0-, 2- and 6-month intervals. RESULTS Of 193 adolescents who received 3-dose infant HBV vaccination, 6 were receiving HAART during vaccination, median (interquartile range) current age 14.5 (11.7-16.2) years, 7 (3.6%) had positive anti-HBc (indicating breakthrough infection), of which 4 (2%) had positive hepatitis B surface antigen (indicating chronic infection). Twenty-two (11.4%) adolescents had protective anti-HBs concentration >10 mIU/mL. Of 164 revaccinated adolescents, 142 (86.6%) had HIV viral load <40 copies/mL. Anti-HBs seroconversion rates >10 mIU/mL were 58.0% (94/162) after the first dose and 97.5% (158/162) after the third dose of revaccination. Forty-five (28%) subjects responded to the first dose with anti-HBs antibody ≥100 mIU/mL had a shorter median duration with CD4 count <15% than their counterparts (6.2 vs. 11.1 months; P = 0.049). CONCLUSIONS Only half of perinatally HIV-infected adolescents were able to elicit anti-HBs response with a single-dose HBV vaccine. Revaccination with 3-dose schedule is required in perinatally HIV-infected adolescents who did not initiate HAART at the time of infant vaccination.
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Brief Report: Immunization of HIV-Infected Adults in the UK With Haemophilus influenzae b/Meningococcal C Glycoconjugate and Pneumococcal Polysaccharide Vaccines. J Acquir Immune Defic Syndr 2017; 73:287-293. [PMID: 27163175 DOI: 10.1097/qai.0000000000001054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
U.K. guidelines for vaccinating HIV-infected adults against bacteria are based on limited data. We compared antibody responses between 211 HIV-infected and 73 HIV-uninfected adults vaccinated with pneumococcal polysaccharide vaccine (PPV) and Haemophilus influenzae b/meningococcal C polysaccharide-tetanus toxoid glycoconjugate vaccine (Hib/MenC-TT). IgG responses to Hib/MenC-TT were not significantly different. PPV induced median IgGs >1.3 μg/mL for 10/12 serotypes among HIV-uninfected participants and 5/12 in HIV-infected participants. HIV-uninfected adults had higher post-vaccination IgGs than HIV-infected adults for 4/12 serotypes (P < 0.001). Responses did not associate with CD4 count or viral suppression. In a U.K. HIV-infected population, Hib/MenC-TT induced similar responses to HIV-uninfected adults, whereas PPV induced poor responses.
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11
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Lopez A, Mariette X, Bachelez H, Belot A, Bonnotte B, Hachulla E, Lahfa M, Lortholary O, Loulergue P, Paul S, Roblin X, Sibilia J, Blum M, Danese S, Bonovas S, Peyrin-Biroulet L. Vaccination recommendations for the adult immunosuppressed patient: A systematic review and comprehensive field synopsis. J Autoimmun 2017; 80:10-27. [PMID: 28381345 DOI: 10.1016/j.jaut.2017.03.011] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/23/2017] [Accepted: 03/27/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Immunosuppressed patients are at risk of severe viral infections-related complications. National and international vaccination guidelines have been developed to decrease the mortality risk associated with these infections. However, a summary of these guidelines and the value of immunisation in this population is missing. OBJECTIVES To summarize specific guidelines regarding vaccination in immunosuppressed patients. METHODS We performed a literature search based on last update vaccine guidelines in immunosuppressed adult patients published between 1/1/2005-1/31/2016 in English or French language using PubMed, Cochrane and Embase, as well as relevant medical society websites. RESULTS Of the 389 citations identified, 12 guidelines were selected Three additional guidelines were selected by searching on the websites from medical societies of each specialty. 15 guidelines were included, involving 19 medical societies issued from the US (n = 6), international collaboration (n = 3), UK (n = 2), Canada (n = 1), Australia (n = 1), France (n = 1), and Germany (n = 1). These guidelines provide recommendations on vaccination in asplenic patients (n = 5), cancer patients (n = 4), HIV patients (n = 5), hematopoietic stem cell recipients (n = 4), inflammatory bowel diseases patients (n = 5), psoriasis patients (n = 4), primary immunocompromised patients (n = 3), inflammatory rheumatic diseases patients (n = 6), and solid organ transplant recipients (n = 5). All guidelines recommended pneumococcal and injectable influenza vaccines. Other inactivated vaccines were recommended only in high risk patients. Live vaccines were usually contraindicated in patients under immunosuppressive therapy and/or in HIV patients with a CD4 count under 200/mm3. CONCLUSION Pneumococcal and injectable influenza are the two essential vaccines recommended in all immunocompromised patients. Other inactivated vaccines are only indicated in high risk patients. Live vaccines are usually contraindicated.
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Affiliation(s)
- Anthony Lopez
- Department of Gastroenterology and Hepatology and Inserm U954, Nancy University Hospital, Lorraine University, Vandoeuvre-lès-Nancy, France
| | - Xavier Mariette
- Université Paris Sud, INSERM, U1184, Center for Immunology of Viral Infections and Autoimmune Diseases, AP-HP, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, Paris, France
| | - Hervé Bachelez
- Sorbonne Paris Cité Université Paris Diderot, INSERM U1163, Institut Imagine, Service de Dermatologie, AP-HP Hôpital Saint-Louis, Paris, France
| | - Alexandre Belot
- Pediatric Nephrology, Rheumatology, Dermatology Unit, Femme Mère Enfant Hospital, INSERM U1111, Hospices Civils de Lyon, Université Lyon 1, France
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital and INSERM U1098, University of Bourgogne-Franche Comté, Dijon, France
| | - Eric Hachulla
- Service de Médecine Interne et Immunologie Clinique, Université de Lille, Centre national de référence Maladies systémiques et auto-immunes rares, Lille, France
| | - Morad Lahfa
- Dermatologist, 6, Rue du Helder, 64200, Biarritz, France
| | - Olivier Lortholary
- University Paris Descartes, Necker Pasteur Center for Infectious Diseases and Tropical Medicine, IHU Imagine, AP-HP, Paris, France
| | | | - Stéphane Paul
- Laboratory of Immunology and Immunomonitoring, CIC 1408 INSERM, GIMAP EA3064, University Hospital of Saint-Etienne, France
| | - Xavier Roblin
- Service de Gastroentérologie, CHU de Saint-Etienne, France
| | - Jean Sibilia
- Department of Rheumatology, Reference Center for Rare Autoimmune Diseases, Division of Internal Medicine, Hautepierre Hospital, University Hospital of Strasbourg, France
| | - Mariela Blum
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Silvio Danese
- Department of Gastroenterology and Department of Biomedical Sciences, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Stefanos Bonovas
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Hepatology and Inserm U954, Nancy University Hospital, Lorraine University, Vandoeuvre-lès-Nancy, France.
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12
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Sadlier C, O'Rourke A, Carr A, Bergin C. Seroepidemiology of hepatitis A, hepatitis B and varicella virus in people living with HIV in Ireland. J Infect Public Health 2017; 10:888-890. [PMID: 28302512 DOI: 10.1016/j.jiph.2017.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 01/28/2017] [Indexed: 01/04/2023] Open
Abstract
Epidemiological studies investigating seroprevalence of vaccine preventable infections at both individual and population level are important in guiding screening and vaccination practices. Data on seroprevalence of common vaccine preventable infections in HIV-infected individuals is lacking. We carried out a retrospective cohort study to investigate serological immunity and factors associated with immunity to hepatitis A virus (HAV), hepatitis B virus (HBV) and varicalla virus (VZV) in a cohort of HIV-infected individuals attending a large ambulatory HIV specialist centre in Ireland. Basic demographic data including risk of acquisition of HIV and region of origin was recorded. Between-group prevalence was compared using the Chi2 test and Wilkoxin signed rank test. Univariate variables with p<0.2 were entered into a multivariate logistic regression model. Of 1287 HIV-infected individuals included in this study (median [SD] age 39 [10] years, 68% male, 46% Irish), 75% were hepatitis A IgG positive, 94% were VZV IgG positive, 3% were HBV surface antigen (sAg) positive while 29% were HBV core antibody (cAb) positive. This study identifies a significant proportion of HIV infected who were susceptible to common vaccine preventable infections. These results highlight the importance of proactive screening and immunization of HIV-infected individuals to ensure optimal protect ionagainst vaccine preventable diseases in this at risk patient group.
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Affiliation(s)
- Corinna Sadlier
- Department of GU Medicine and Infectious Diseases (GUIDE), St James's Hospital, Dublin, Ireland; Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland.
| | - Anna O'Rourke
- Department of GU Medicine and Infectious Diseases (GUIDE), St James's Hospital, Dublin, Ireland.
| | - Alison Carr
- Department of GU Medicine and Infectious Diseases (GUIDE), St James's Hospital, Dublin, Ireland.
| | - Colm Bergin
- Department of GU Medicine and Infectious Diseases (GUIDE), St James's Hospital, Dublin, Ireland; Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland.
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13
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Storey HL, Singa B, Naulikha J, Horton H, Richardson BA, John-Stewart G, Walson JL. Soil transmitted helminth infections are not associated with compromised antibody responses to previously administered measles and tetanus vaccines among HIV-1 infected, ART naïve Kenyan adults. Parasite Epidemiol Control 2017; 2:13-20. [PMID: 28924616 PMCID: PMC5600515 DOI: 10.1016/j.parepi.2016.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In many regions of sub-Saharan Africa, both HIV and helminth infections are prevalent. HIV-1 (human immunodeficiency virus type 1) and helminth infections can both compromise immune responses in humans. To determine whether the presence of helminth infection or the treatment of helminth infection alters unstimulated vaccine responses among HIV-1 infected individuals, we conducted two nested serologic studies. Blood samples were collected for HIV disease monitoring and vaccine-specific serologic assays, while stool was evaluated by direct microscopy methods. We compared antibody responses to measles and tetanus vaccines in helminth-infected (Ascaris, Trichuris, hookworm and/or Schistosoma mansoni) and uninfected adults 18 years and older (n = 100). We also compared measles and tetanus antibody responses in Ascaris only-infected adults receiving 400 mg albendazole daily for 3 days (n = 16) vs. placebo (n = 19) in a separate study. In both cohorts, over 70% of participants had measles and tetanus responses above the protective threshold. Prevalence of measles responses were similar between helminth-infected and uninfected individuals (82%, 95% CI: 71–93% vs 72%, 95% CI: 59–85%), as well as log10 tetanus antibody levels (− 0.133 IU/mL vs − 0.190 IU/mL, p > 0.05), and did not differ by helminth species. In the Ascaris-infected cohort, changes in measles responses and tetanus responses did not differ between those who received anthelminthic vs. placebo (p > 0.05 for both). In these studies, neither helminth infection, nor deworming, appeared to affect previously administered vaccine responsiveness in HIV-1 infected, ART naïve, adults in Kenya.
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Affiliation(s)
- Helen L. Storey
- Department of Epidemiology, University of Washington, 325 9th Ave, Seattle, WA 98104, USA
- Corresponding author at: Diagnostics Program, PATH, PO Box 900922, Seattle, WA, USA.
| | - Benson Singa
- Kenya Medical Research Institute, Mbagathi Rd, Nairobi, Kenya
| | - Jackie Naulikha
- Kenya Medical Research Institute, Mbagathi Rd, Nairobi, Kenya
| | - Helen Horton
- Seattle Biomedical Research Institute, 307 Westlake Ave N #500, Seattle, WA, USA
| | - Barbra A. Richardson
- Department of Biostatistics, University of Washington, 325 9th Ave, Seattle, WA 98104, USA
| | - Grace John-Stewart
- Department of Epidemiology, University of Washington, 325 9th Ave, Seattle, WA 98104, USA
- Department of Global Health, University of Washington, 325 9th Ave, Seattle, WA 98104, USA
- Department of Allergy and Infectious Diseases, University of Washington, 325 9th Ave, Seattle, WA 98104, USA
| | - Judd L. Walson
- Department of Epidemiology, University of Washington, 325 9th Ave, Seattle, WA 98104, USA
- Department of Global Health, University of Washington, 325 9th Ave, Seattle, WA 98104, USA
- Department of Allergy and Infectious Diseases, University of Washington, 325 9th Ave, Seattle, WA 98104, USA
- Department of Pediatrics, University of Washington, 325 9th Ave, Seattle, WA 98104, USA
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14
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Harrison N, Poeppl W, Herkner H, Tillhof KD, Grabmeier-Pfistershammer K, Rieger A, Forstner C, Burgmann H, Lagler H. Predictors for and coverage of influenza vaccination among HIV-positive patients: a cross-sectional survey. HIV Med 2016; 18:500-506. [PMID: 28035738 DOI: 10.1111/hiv.12483] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Influenza vaccination is recommended for HIV-infected patients, but limited data about vaccination rates are available. The aim of this study was to evaluate the coverage of and predictors for influenza vaccination among HIV-positive patients. METHODS All HIV-positive patients who visited the HIV out-patient department of the University Hospital of Vienna, Austria, between June and August 2015 were asked to participate in this survey by completing a questionnaire. RESULTS A total of 455 HIV-positive patients completed a questionnaire, with 359 male and 96 female participants with a mean age of 46 years. The influenza vaccination rate for the previous season (2014/2015) was 11.9% [n = 54/455; 95% confidence interval (CI) 9.2-15.2%]. Older age was significantly associated with a positive influenza vaccination status. Obtaining information through a medical consultation or receiving a direct recommendation for vaccination by a physician had a significant impact on vaccination behaviour. The probability of being vaccinated against influenza was about 13 times higher among patients who received a recommendation for vaccination by their family physician or by their HIV specialist (P < 0.001). Important reasons for declining vaccination were fear of side effects (39%), not considering influenza as a severe disease (36%) and reasons related to HIV: 17% were worried that the vaccine could worsen the course of HIV infection and 16% believed vaccination would fail because of their compromised immune system. CONCLUSIONS A low influenza vaccination rate of 11.9% was detected in this HIV-positive cohort. The most effective impact for a positive vaccination status was direct recommendation of the influenza vaccine by the attending physician.
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Affiliation(s)
- N Harrison
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - W Poeppl
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria.,Division of General Dermatology, Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - H Herkner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - K D Tillhof
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - K Grabmeier-Pfistershammer
- Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - A Rieger
- Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - C Forstner
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria.,Center of Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - H Burgmann
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - H Lagler
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
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15
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Lesourd A, Leporrier J, Delbos V, Unal G, Honoré P, Etienne M, Bouchaud O, Caron F. Antiretroviral Therapy as Prevention of … Pneumococcal Infections? Open Forum Infect Dis 2016; 3:ofw228. [PMID: 28018929 PMCID: PMC5170497 DOI: 10.1093/ofid/ofw228] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 10/21/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Despite antiretroviral therapy, it is generally believed that the risk for pneumococcal infections (PnIs) is high among patients infected with human immunodeficiency virus (HIV). However, most studies in this field have been conducted before 2010, and the proportion of virologically suppressed patients has drastically increased in these latter years thanks to larger indications and more effective antiretroviral regimens. This study aimed to re-evaluate the current risk of PnI among adult patients infected with HIV. METHODS The incidence of PnI was evaluated between 1996 and 2014 in 2 French regional hospitals. The 80 most recent cases of PnI (2000-2014) were retrospectively compared with 160 controls (HIV patients without PnI) to analyze the residual risk factors of PnI. RESULTS Among a mean annual follow-up cohort of 1616 patients, 116 PnIs were observed over 18 years. The risk factors of PnI among patients infected with HIV were an uncontrolled HIV infection or "classic" risk factors of PnI shared by the general population such as addiction, renal or respiratory insufficiency, or hepatitis B or C coinfection. Pneumococcal vaccination coverage was low and poorly targeted, because only 5% of the cases had been previously vaccinated. The incidence of invasive PnIs among HIV patients with a nonvirologically suppressed infection or comorbidities was 12 times higher than that reported in the general population at the country level (107 vs 9/100000 patients), whereas the incidence among virologically suppressed HIV patients without comorbidities was lower (7.6/100000 patients). CONCLUSIONS Human immunodeficiency virus infection no longer per se seems to be a significant risk factor for PnI, suggesting a step-down from a systematic to an "at-risk patient" targeted pneumococcal vaccination strategy.
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Affiliation(s)
- Anaïs Lesourd
- Centre Hospitalo-Universitaire Charles Nicolle, Service de Maladies Infectieuses et Tropicales , Rouen, France
| | - Jérémie Leporrier
- Centre Hospitalo-Universitaire Charles Nicolle, Service de Maladies Infectieuses et Tropicales , Rouen, France
| | - Valérie Delbos
- Centre Hospitalo-Universitaire Charles Nicolle, Service de Maladies Infectieuses et Tropicales, Rouen, France;; Groupe de Recherche sur l'Adaptation Microbienne (2.0-EA 2656, Institut de Recherche et d'Innovation Biomédicale), Normandie Université, Rouen, France
| | - Guillemette Unal
- Centre Hospitalo-Universitaire Charles Nicolle, Service de Maladies Infectieuses et Tropicales, Rouen, France;; Groupe de Recherche sur l'Adaptation Microbienne (2.0-EA 2656, Institut de Recherche et d'Innovation Biomédicale), Normandie Université, Rouen, France
| | - Patricia Honoré
- Centre Hospitalo-Universitaire Avicenne, Service de Maladies Infectieuses et Tropicales , Bobigny, France
| | - Manuel Etienne
- Centre Hospitalo-Universitaire Charles Nicolle, Service de Maladies Infectieuses et Tropicales, Rouen, France;; Groupe de Recherche sur l'Adaptation Microbienne (2.0-EA 2656, Institut de Recherche et d'Innovation Biomédicale), Normandie Université, Rouen, France
| | - Olivier Bouchaud
- Centre Hospitalo-Universitaire Avicenne, Service de Maladies Infectieuses et Tropicales , Bobigny, France
| | - François Caron
- Centre Hospitalo-Universitaire Charles Nicolle, Service de Maladies Infectieuses et Tropicales, Rouen, France;; Groupe de Recherche sur l'Adaptation Microbienne (2.0-EA 2656, Institut de Recherche et d'Innovation Biomédicale), Normandie Université, Rouen, France
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16
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Sadlier C, O’Dea S, Bennett K, Dunne J, Conlon N, Bergin C. Immunological efficacy of pneumococcal vaccine strategies in HIV-infected adults: a randomized clinical trial. Sci Rep 2016; 6:32076. [PMID: 27580688 PMCID: PMC5007521 DOI: 10.1038/srep32076] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 07/18/2016] [Indexed: 02/01/2023] Open
Abstract
The aim of this study was to compare the immunologic response to a prime-boost immunization strategy combining the 13-valent conjugate pneumococcal vaccine (PCV13) with the 23-valent polysaccharide pneumococcal vaccine (PPSV23) versus the PPSV23 alone in HIV-infected adults. HIV-infected adults were randomized to receive PCV13 at week 0 followed by PPSV23 at week 4 (n = 31, prime-boost group) or PPSV23 alone at week 4 (n = 33, PPSV23-alone group). Serotype specific IgG geometric mean concentration (GMC) and functional oposonophagocytic (OPA) geometric mean titer (GMT) were compared for 12 pneumococcal serotypes shared by both vaccines at week 8 and week 28. The prime-boost vaccine group were more likely to achieve a ≥2-fold increase in IgG GMC and a GMC >1 ug/ml at week 8 (odds ratio (OR) 2.00, 95% confidence interval (CI) 1.46-2.74, p < 0.01) and week 28 (OR 1.95, 95% CI 1.40-2.70, p < 0.01). Similarly, the prime-boost vaccine group were more likely to achieve a ≥4-fold increase in GMT at week 8 (OR 1.71, 95% CI 1.22-2.39, p < 0.01) and week 28 (OR 1.6, 95% CI 1.15-2.3, p < 0.01). This study adds to evidence supporting current pneumococcal vaccination recommendations combining the conjugate and polysaccharide pneumococcal vaccines in the United States and Europe for HIV-infected individuals.
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Affiliation(s)
- C. Sadlier
- Department of GU Medicine and Infectious Diseases (GUIDE), St James’s Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - S. O’Dea
- Department of GU Medicine and Infectious Diseases (GUIDE), St James’s Hospital, Dublin, Ireland
| | - K. Bennett
- Population Health Sciences Division, Royal College of Surgeons in Ireland, St Stephens Green, Dublin 2, Ireland
| | - J. Dunne
- Department of Immunology, St James’s Hospital, Dublin, Ireland
| | - N. Conlon
- Department of Immunology, St James’s Hospital, Dublin, Ireland
| | - C. Bergin
- Department of GU Medicine and Infectious Diseases (GUIDE), St James’s Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
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Long-term immune responses and comparative effectiveness of one or two doses of 7-valent pneumococcal conjugate vaccine (PCV7) in HIV-positive adults in the era of combination antiretroviral therapy. J Int AIDS Soc 2016; 19:20631. [PMID: 26829360 PMCID: PMC4733944 DOI: 10.7448/ias.19.1.20631] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 12/04/2015] [Accepted: 12/21/2015] [Indexed: 12/04/2022] Open
Abstract
Introduction HIV infection impairs maintenance of immunological memory, yet few studies of HIV-positive adults receiving 7-valent pneumococcal conjugate vaccine (PCV7) have followed them beyond the first year. We determined and compared the durability of serological responses and the clinical outcomes of HIV-positive adults annually for five years following vaccination with one or two doses of PCV7. Methods In this non-randomized clinical trial, 221 pneumococcal vaccine-naïve HIV-positive adults receiving one (n=109) or two doses four weeks apart (n=112) of PCV7 between 2008 and 2010 were longitudinally followed for evaluation of significant serological response and for episodes of pneumonia and invasive pneumococcal disease. Results At the time of vaccination, the two groups were well matched for age, risk factors, combination antiretroviral therapy (cART) coverage, CD4 count and plasma HIV RNA load (PVL). At the end of five years, the CD4 counts for the one- and two-dose groups had increased from 407 and 406 to 550 and 592 cells/µL, respectively, and 82.4 and 81.6% of the participants had fully suppressed PVL. Significant immune responses to ≥2 serotypes persisted for 67.9 vs 78.6%, 64.2 vs 71.4%, 66.1 vs 71.4%, 57.8 vs 69.6% in the second, third, fourth and fifth years after one and two doses of PCV7 in the intention-to-treat analysis, respectively. In multivariate analysis, immunization with two doses of PCV7 (odds ratio (OR) 1.71, 95% confidence interval (CI) 1.10 to 2.65, p=0.016), concurrent cART (OR 2.16, 95% CI 1.16 to 4.00, p=0.015) and CD4 proliferation (OR 1.12, 95% CI 1.01 to 1.27, p=0.031) were predictive of persistent serological responses in the fifth year. Only one patient in the one-dose group had documented pneumococcal pneumonia (non-bacteraemic) and none had invasive pneumococcal disease in the 6.5 years of follow-up. Conclusions One or two doses of PCV7 achieve durable seroprotective responses in HIV-treated participants; however, two doses may be more robust than one dose in a larger study population or in real-world populations with less cART coverage.
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18
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Simmons RD, Kirwan P, Beebeejaun K, Riordan A, Borrow R, Ramsay ME, Delpech V, Lattimore S, Ladhani S. Risk of invasive meningococcal disease in children and adults with HIV in England: a population-based cohort study. BMC Med 2015; 13:297. [PMID: 26654248 PMCID: PMC4674945 DOI: 10.1186/s12916-015-0538-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 11/26/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Recent studies have identified HIV infection as a potential risk factor for invasive meningococcal disease (IMD), suggesting that HIV-infected individuals could benefit from meningococcal vaccination to reduce their risk of this rare, but severe and potentially fatal infection. In the United Kingdom, as in most industrialised countries, HIV is not considered a risk factor for IMD. METHODS IMD incidence and relative risk by age group and meningococcal capsular group in HIV-positive compared with HIV-uninfected individuals was estimated through data linkage of national datasets in England between 2011 and 2013. RESULTS IMD incidence among persons diagnosed with HIV was 6.6 per 100,000 compared to 1.5 per 100,000 among HIV-negative individuals, with a relative risk of 4.5 (95 % CI, 2.7-7.5). All but one case occurred in adults aged 16-64 years, who had a 22.7-fold (95 % CI, 12.4-41.6; P <0.001) increased risk compared with the HIV-negative adults. IMD risk by capsular group varied with age. HIV-positive children and adolescents had a higher risk of meningococcal group B disease, while adults were at increased risk of groups C, W and Y disease. Most HIV-positive individuals had been born in Africa, had acquired HIV through heterosexual contact, and were known to be HIV-positive and receiving antiretroviral treatment at IMD diagnosis. The most common clinical presentation was septicemia and, although intensive care admission was common, none died of IMD. CONCLUSIONS HIV-positive children and adults are at significantly increased risk of IMD, providing an evidence base for policy makers to consider HIV as a risk factor for meningococcal vaccination.
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Affiliation(s)
- Ruth D Simmons
- Immunisation Department, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK.
| | - Peter Kirwan
- HIV and STI Department, Public Health England, London, UK
| | - Kazim Beebeejaun
- Immunisation Department, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | | | - Ray Borrow
- Vaccine Evaluation Unit, Public Health England, Manchester, UK
| | - Mary E Ramsay
- Immunisation Department, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | | | - Samuel Lattimore
- Immunisation Department, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Shamez Ladhani
- Immunisation Department, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
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19
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Ellis J, Brown J, Smith C, Snell L, Capocci S, Ferro F, Ferreira J, Marshall N, Webster D, Johnson M, Lipman M. Influenza immunisation: knowledge and actions taken by UK HIV-positive adults. HIV Med 2015; 17:397-9. [DOI: 10.1111/hiv.12309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- J Ellis
- Departments of Respiratory and HIV Medicine; Royal Free London NHS Foundation Trust; London UK
| | - J Brown
- Departments of Respiratory and HIV Medicine; Royal Free London NHS Foundation Trust; London UK
- Division of Medicine; University College London; London UK
| | - C Smith
- Department of Infection and Population Health; University College London; London UK
| | - L Snell
- Departments of Respiratory and HIV Medicine; Royal Free London NHS Foundation Trust; London UK
| | - S Capocci
- Departments of Respiratory and HIV Medicine; Royal Free London NHS Foundation Trust; London UK
| | - F Ferro
- Departments of Respiratory and HIV Medicine; Royal Free London NHS Foundation Trust; London UK
| | - J Ferreira
- Departments of Respiratory and HIV Medicine; Royal Free London NHS Foundation Trust; London UK
| | - N Marshall
- Departments of Respiratory and HIV Medicine; Royal Free London NHS Foundation Trust; London UK
| | - D Webster
- Departments of Respiratory and HIV Medicine; Royal Free London NHS Foundation Trust; London UK
| | - M Johnson
- Departments of Respiratory and HIV Medicine; Royal Free London NHS Foundation Trust; London UK
| | - M Lipman
- Departments of Respiratory and HIV Medicine; Royal Free London NHS Foundation Trust; London UK
- Division of Medicine; University College London; London UK
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20
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de Ruiter A, Taylor GP, Clayden P, Dhar J, Gandhi K, Gilleece Y, Harding K, Hay P, Kennedy J, Low-Beer N, Lyall H, Palfreeman A, O'Shea S, Tookey P, Tosswill J, Welch S, Wilkins E. British HIV Association guidelines for the management of HIV infection in pregnant women 2012 (2014 interim review). HIV Med 2015; 15 Suppl 4:1-77. [PMID: 25604045 DOI: 10.1111/hiv.12185] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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21
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Abstract
Hepatitis B and A account for considerable morbidity and mortality worldwide. Immunization is the most effective means of preventing hepatitis B and A. However, the immune response to both hepatitis vaccines seems to be reduced in HIV-infected subjects. The aim of this review was to analyze the immunogenicity, safety, long-term protection and current recommendations of hepatitis B and A vaccination among HIV-infected adults. The factors most frequently associated with a deficient level of anti-HBs or IgG anti-HAV after vaccination are those related to immunosuppression (CD4 level and HIV RNA viral load) and to the frequency of administration and/or the amount of antigenic load per dose. The duration of the response to both HBV and HAV vaccines is associated with suppression of the viral load at vaccination and, in the case of HBV vaccination, with a higher level of antibodies after vaccination. In terms of safety, there is no evidence of more, or different, adverse effects compared with HIV-free individuals. Despite literature-based advice on the administration of alternative schedules, revaccination after the failure of primary vaccination, and the need for periodic re-evaluation of antibody levels, few firm recommendations are found in the leading guidelines.
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Affiliation(s)
- G Mena
- a Department of Preventive Medicine & Care Quality ; Hospital General Universitario de Castellón ; Castellón de la Plana , Spain
| | - A L García-Basteiro
- b ISGlobal; Barcelona Ctr. Int. Health Res. (CRESIB); Hospital Clínic - Universitat de Barcelona ; Barcelona , Spain.,c Centro de Investigação em Saúde deg Manhiça (CISM) ; Manhiça, Maputo , Mozambique
| | - J M Bayas
- b ISGlobal; Barcelona Ctr. Int. Health Res. (CRESIB); Hospital Clínic - Universitat de Barcelona ; Barcelona , Spain.,d Department of Preventive Medicine & Epidemiology ; Hospital Clínic de Barcelona; Universitat de Barcelona ; Barcelona , Spain
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22
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Grabmeier-Pfistershammer K, Herkner H, Touzeau-Roemer V, Rieger A, Burgmann H, Poeppl W. Low tetanus, diphtheria and acellular pertussis (Tdap) vaccination coverage among HIV infected individuals in Austria. Vaccine 2015; 33:3929-32. [PMID: 26102535 DOI: 10.1016/j.vaccine.2015.06.056] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 06/10/2015] [Accepted: 06/11/2015] [Indexed: 11/26/2022]
Abstract
Current management guidelines of HIV infected adults include recommendation to immunization against common vaccine preventable diseases. This effort is hindered by the scarce knowledge regarding the immunization status of this especially vulnerable patient group. This study analyzed the serostatus for pertussis, diphtheria and tetanus of more than 700 HIV infected individuals residing in Austria. These individuals were representative for the Austrian HIV cohort regarding sex, age, transmission risk and HIV progression markers. Overall, 73.6% were on suppressive HAART, mean CD4 cell count was 603c/μl. Seropositivity was 84% for diphtheria, 51% for tetanus and 1% for pertussis. Migrants had a lower chance of tetanus seropositivity (OR 0.30 (CI 0.21 to 0.43)). Increase in CDC classification were associated with increased diphtheria seropositivity (OR 1.42 (CI 1.02 to 1.98)) and a CD4 nadir<200c/μl was associated with increased pertussis seropositivity (OR 12.2, 95% CI 1.2 to 121). Importantly due to the well preserved immune status of nearly all participants vaccination would be feasible in the majority of the seronegative patients. In patients with a CD4 count>200c/μl, 95% lacked seroprotection to at least one of the antigens included in the triple vaccine Tdap and could be vaccinated. Thus, a proactive approach would largely reduce the number of patients at risk for these vaccine-preventable diseases.
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Affiliation(s)
- K Grabmeier-Pfistershammer
- Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology, Medical University Vienna, Vienna, Austria
| | - H Herkner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - V Touzeau-Roemer
- Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology, Medical University Vienna, Vienna, Austria
| | - A Rieger
- Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology, Medical University Vienna, Vienna, Austria
| | - H Burgmann
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
| | - W Poeppl
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria; Division of General Dermatology, Department of Dermatology, Medical University of Vienna, Vienna, Austria
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23
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Sadarangani M, Tam H, McDonald S, Fidler S, Foster C. Response to Hepatitis B virus vaccine in young adults with perinatally acquired HIV infection. J Infect 2015; 71:495-7. [PMID: 26072139 DOI: 10.1016/j.jinf.2015.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 06/01/2015] [Accepted: 06/03/2015] [Indexed: 02/08/2023]
Affiliation(s)
- Manish Sadarangani
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and NIHR Biomedical Research Centre, Oxford University Hospitals NHS Trust, Oxford, UK.
| | - Herman Tam
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Sarah Fidler
- Imperial College Healthcare NHS Trust, London, UK
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24
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Thornhill J, Sivaramakrishnan A, Orkin C. Pneumococcal vaccination in people living with HIV. Vaccine 2015; 33:3159-60. [DOI: 10.1016/j.vaccine.2014.07.086] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 07/29/2014] [Indexed: 11/29/2022]
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25
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Mena G, Vilajeliu A, Urbiztondo L, Bayas JM. [Regional recommendations on hepatitis vaccination in human immunodeficiency virus infected adult patients in Spain: Evidence-based disparity?]. Med Clin (Barc) 2015; 145:163-70. [PMID: 25771339 DOI: 10.1016/j.medcli.2014.12.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 12/17/2014] [Accepted: 12/20/2014] [Indexed: 01/18/2023]
Affiliation(s)
- Guillermo Mena
- Servicio de Medicina Preventiva y Calidad Asistencial, Hospital General Universitari de Castelló, Castelló de la Plana, España
| | - Alba Vilajeliu
- Servicio de Medicina Preventiva y Epidemiología ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, España
| | - Luis Urbiztondo
- Agència de Salut Pública de Catalunya, Departament de Salut, Generalitat de Catalunya, Barcelona, España
| | - José M Bayas
- Servicio de Medicina Preventiva y Epidemiología ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, España.
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26
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O'Bryan TA, Rini EA, Okulicz J, Messner O, Ganesan A, Lalani T, Bavaro MF, O'Connell RJ, Agan BK, Landrum ML. HIV viraemia during hepatitis B vaccination shortens the duration of protective antibody levels. HIV Med 2015; 16:161-7. [PMID: 25586899 DOI: 10.1111/hiv.12189] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2014] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Individuals with HIV infection often have early waning of protective antibody following hepatitis B virus (HBV) vaccination. HIV viraemia at the time of vaccination may limit the durability of serum anti-HBV surface antibody (HBsAb) levels. We investigated the relationship of HIV plasma viral load (VL) and duration of HBsAb among vaccinees enrolled in the US Military HIV Natural History Study. METHODS We included in the study participants who had no history of prior HBV infection, who had received all HBV vaccine doses after HIV diagnosis, and who had demonstrated an initial vaccine response, defined as HBsAb ≥ 10 IU/L. Responders were retrospectively followed with serial HBV serology from the time of the last vaccine dose until the development of waning (HBsAb < 10 IU/L) or the last HBsAb measurement. Time to and risk for waning were evaluated with Kaplan-Meier survival methods and Cox proportional hazards models, respectively. RESULTS A total of 186 initial vaccine responders were identified. During 570 person-years of observation, HBsAb waned in 52 of 186 participants (28%). The cumulative proportion maintaining HBsAb ≥ 10 IU/L was 83% at 2 years and 56% at 5 years. Participants with an undetectable VL [hazard ratio (HR) 0.37; 95% confidence interval (CI) 0.18-0.76] or with detectable VL of ≤ 10 000 copies/mL (HR 0.46; 95% CI 0.21-1.00) had reduced risk of waning. Other factors including age, number of vaccine doses, CD4 count, and receipt of highly active antiretroviral therapy (HAART) were not significantly associated with risk of waning HBsAb. CONCLUSIONS Undetectable or low HIV VL at the time of HBV vaccination is associated with greater durability of vaccine response in patients with HIV infection.
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Affiliation(s)
- T A O'Bryan
- Infectious Disease Clinical Research Program, Uniformed Services University, Bethesda, MD, USA; San Antonio Military Medical Center, Fort Sam Houston, TX, USA
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27
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Cooper C, Klein M, Walmsley S, Haase D, MacKinnon-Cameron D, Marty K, Li Y, Smith B, Halperin S, Law B, Scheifele D. High-Level Immunogenicity Is Achieved Vaccine With Adjuvanted Pandemic H1N12009and Improved With Booster Dosing in a Randomized Trial of HIV-Infected Adults. HIV CLINICAL TRIALS 2015. [DOI: 10.1310/hct1301-23] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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28
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Kourkounti S, Paparizos V, Leuow K, Paparizou E, Antoniou C. Adherence to hepatitis A virus vaccination in HIV-infected men who have sex with men. Int J STD AIDS 2014; 26:852-6. [PMID: 25411352 DOI: 10.1177/0956462414560274] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 10/13/2014] [Indexed: 01/25/2023]
Abstract
Although vaccination against hepatitis A virus (HAV) is essential for human immunodeficiency virus (HIV)-infected patients, the uptake of HAV vaccine is reported to be very low. From 2007 to 2012, 912 HIV-infected men in Athens, Greece were screened for exposure to HAV. Two doses of an HAV vaccine were recommended to 569 eligible patients. Reminder cards with scheduled vaccination visits were given to each patient. Among eligible patients, 62.2% (354/569) received both doses. Patients who were fully vaccinated compared with non-adherent patients were natives, older, had undetectable HIV viral load, higher CD4 T cell counts and lower nadir CD4 T cell counts. Multivariate logistic regression revealed that the patient's country of origin (p = 0.024; OR = 2.712; 95% CI, 1.139-6.457), CD4 T cell count (p < 0.001) and nadir CD4 T cell count (p < 0.001) were factors directly associated with adherence. In conclusion, adherence to HAV vaccination was better than in previously published data. Because many of the factors related to vaccination completion are parameters of HIV infection, it appears that physician interest in HIV care and vaccination planning is crucial to enhancing vaccine uptake.
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Affiliation(s)
- Sofia Kourkounti
- HIV/AIDS Unit, Department of Dermatology and Venereology, "A.Sygros" Hospital, Athens, Greece
| | - Vassilios Paparizos
- HIV/AIDS Unit, Department of Dermatology and Venereology, "A.Sygros" Hospital, Athens, Greece
| | - Kirsten Leuow
- HIV/AIDS Unit, Department of Dermatology and Venereology, "A.Sygros" Hospital, Athens, Greece
| | - Eleni Paparizou
- HIV/AIDS Unit, Department of Dermatology and Venereology, "A.Sygros" Hospital, Athens, Greece
| | - Christina Antoniou
- HIV/AIDS Unit, Department of Dermatology and Venereology, "A.Sygros" Hospital, Athens, Greece
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29
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Okwen MP, Reid S, Njei B, Mbuagbaw L. Hepatitis B vaccination for reducing morbidity and mortality in persons with HIV infection. Cochrane Database Syst Rev 2014; 10:CD009886. [PMID: 25300375 PMCID: PMC4830339 DOI: 10.1002/14651858.cd009886.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hepatitis B vaccine has been recommended for use in people living with HIV (PLHIV) mostly because of the similarities in routes of infection and their prevalence in the same geographic areas. PLHIV may not develop sero-protection after receiving standard hepatitis B vaccine due to their compromised immune status. OBJECTIVES To evaluate the efficacy of hepatitis B virus vaccine in PLHIV compared to placebo or no vaccine. SEARCH METHODS We searched 6 English language databases in July 2012, and updated the search in June 2013 and August 2014. We searched the grey literature, conference proceedings, specialised web sites, and contacted experts in the field. SELECTION CRITERIA Randomised controlled trials of hepatitis B vaccine compared to placebo or no vaccine, evaluating relevant outcomes of efficacy and safety. DATA COLLECTION AND ANALYSIS Two review authors independently sought and extracted data on study design, participants, hepatitis B infection, hepatitis B related morbidity and mortality, anti-HBs immunogenicity and adverse effects related to vaccines from published articles or through correspondence with authors. Data were analysed qualitatively. MAIN RESULTS One double-blind randomised controlled trial with 26 participants who were on antiretroviral therapy (ART), comparing hepatitis B vaccine to placebo conducted in Spain met our eligibility criteria and was included in this review. The study ran for three years and participants were followed up on a monthly basis. The study reported adequate humoral response to vaccine at 12 months and no local or systematic side effects in both intervention and control groups. This humoral response was lost when the participants stopped taking ART. The sample size of the study was small and the study was conducted in a high income setting unlike the areas of highest burden of hepatitis B and HIV co-infections. AUTHORS' CONCLUSIONS The evidence from this study is insufficient to support any recommendations regarding the use of hepatitis B vaccine in PLHIV. Neither does this evidence demonstrate that hepatitis B vaccine is unsafe in PLHIV. Further randomised controlled trials in high prevalence areas are required to generate evidence on the long term efficacy and safety of hepatitis B vaccine in PLHIV with and without ART. Different regimens and routes of administration should also be explored.
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Affiliation(s)
- Mbah P Okwen
- Centre for the Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Savanna Reid
- Department of Epidemiology and Biostatistics, University of Nevada, Las Vegas, Henderson, Nevada, USA
| | - Basile Njei
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Lawrence Mbuagbaw
- Centre for the Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
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30
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Grabmeier-Pfistershammer K, Poeppl W, Herkner H, Touzeau-Roemer V, Huschka E, Rieger A, Burgmann H. High need for MMR vaccination in HIV infected adults in Austria. Vaccine 2014; 32:6020-3. [PMID: 25203449 DOI: 10.1016/j.vaccine.2014.07.114] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 06/26/2014] [Accepted: 07/01/2014] [Indexed: 10/24/2022]
Abstract
Current guidelines recommend screening for HIV infected patients susceptible for vaccine preventable diseases and offering of immunization. However, data regarding the vaccination coverage among this group are largely missing. This study analyzed the serostatus for Measles, Mumps and Rubella of more than 700 HIV infected patients residing in Austria. These patients were representative for the Austrian HIV cohort regarding sex, age, transmission risk and HIV progression markers. 73.6% were on suppressive HAART, mean CD4 cell count was 603c/μl. Seronegativity was 8.4% for Measles, 33.4% for Mumps and 18.8% for Rubella. In total, out of the 713 HIV infected adults analyzed, almost half (47.8%) would require MMR vaccination. In a multivariate analysis migration was significantly associated with seronegativity for Measles (OR 0.5, CI 0.27-0.9) and Mumps (OR 0.57, CI 0.39-0.81). Importantly due to the well preserved immune status of nearly all participants vaccination would be feasible in the majority of the seronegative patients. Thus, a proactive approach would largely reduce the number of patients at risk for vaccine-preventable diseases.
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Affiliation(s)
- K Grabmeier-Pfistershammer
- Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology, Medical University Vienna, Austria.
| | - W Poeppl
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Austria
| | - H Herkner
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - V Touzeau-Roemer
- Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology, Medical University Vienna, Austria
| | - Emilia Huschka
- Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology, Medical University Vienna, Austria
| | - A Rieger
- Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology, Medical University Vienna, Austria
| | - H Burgmann
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Austria
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31
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Filippelli M, Lionetti E, Gennaro A, Lanzafame A, Arrigo T, Salpietro C, La Rosa M, Leonardi S. Hepatitis B vaccine by intradermal route in non responder patients: An update. World J Gastroenterol 2014; 20:10383-10394. [PMID: 25132754 PMCID: PMC4130845 DOI: 10.3748/wjg.v20.i30.10383] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 03/12/2014] [Accepted: 04/29/2014] [Indexed: 02/06/2023] Open
Abstract
Vaccination is the main prophylactic measure to reduce the mortality caused by hepatitis B virus (HBV) infection in healthy subjects since the immune response to hepatitis B recombinant vaccination occurs in over 90% of general population. Individuals who develop an anti-HBs titer less than 10 mIU/mL after primary vaccination cycle are defined “no responders”. Many factors could cause a non response to the HBV vaccination, such as administration of the vaccine in buttocks, impaired vaccine storage conditions, drug abuse, smoking, infections and obesity. Moreover there are some diseases, like chronic kidney disease, human immunodeficiency virus infection, chronic liver disease, celiac disease, thalassaemia, type I diabetes mellitus, down’s syndrome and other forms of mental retardation that are characterized by a poorer response to HBV vaccination than healthy subjects. To date it is still unclear how to treat this group of patients at high risk of hepatitis B infection. Recent studies seem to indicate that the administration of HBV recombinant vaccine by the intradermal route is very effective and could represent a more useful strategy than intramuscular route. This review focuses on the use of anti hepatitis B vaccine by intradermal route as alternative to conventional intramuscular vaccine in all non responder patients. A comprehensive review of the literature using PubMed database, with appropriate terms, was undertaken for articles in English published since 1983. The literature search was undertaken in September 2013.
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32
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Li EH, Foisy MM. Antiretroviral and Medication Errors in Hospitalized HIV-Positive Patients. Ann Pharmacother 2014; 48:998-1010. [DOI: 10.1177/1060028014534195] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To summarize the literature regarding antiretroviral and other medication errors in hospitalized HIV-positive patients and to discuss potential interventions and solutions that have been studied to minimize drug error. Data Sources: A systematic search of MEDLINE, PubMed, and EMBASE (2000-April 2014) was conducted. Search terms included HIV/AIDS, HAART, hospitalization, patient admission, inpatient, patient transfer, medication error, inappropriate prescribing, drug interaction, drug omission, drug toxicity, and contraindication. Study Selection and Data Extraction: English-language research articles, case reports, conference abstracts, and letters to the editor were reviewed. Data Synthesis: A high overall medication error rate was reported in HIV-positive inpatients. Errors occurred mainly at the time of prescribing on admission but were also detected throughout hospitalization and at discharge. Errors in the antiretroviral regimen, dosing, scheduling, and drug-drug and drug-food interactions were the most common. The most successful interventions involved a clinical pharmacist, who specializes in infectious diseases and/or HIV, completing medication reconciliation on admission, reviewing orders daily, and screening for errors at discharge. Conclusions: Although studies varied greatly in methodology, overall, a large number of medication errors occurred in this patient population. This underscores the important role the pharmacist has in optimizing care to hospitalized HIV-positive patients and provides further insights into the types of medication errors that occur and proposed solutions to reduce these errors. Because medication errors are multifactorial, ongoing initiatives to improve the quality of medication reconciliation processes, educate the health care team on antiretroviral medications, and improve the drug distribution system are required.
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Affiliation(s)
- Emily H. Li
- PharmD Student, University of Alberta, Edmonton, AB, Canada
| | - Michelle M. Foisy
- Northern Alberta Program, Royal Alexandra Hospital, Edmonton, AB, Canada
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33
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de Silva TI, Green ST, Cole J, Stone BJ, Dockrell DH, Vedio AB. Successful use of Fendrix in HIV-infected non-responders to standard hepatitis B vaccines. J Infect 2014; 68:397-9. [DOI: 10.1016/j.jinf.2013.12.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 12/16/2013] [Accepted: 12/17/2013] [Indexed: 11/30/2022]
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34
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Mizusawa M, Perlman DC, Lucido D, Salomon N. Rapid loss of vaccine-acquired hepatitis B surface antibody after three doses of hepatitis B vaccination in HIV-infected persons. Int J STD AIDS 2014; 25:201-6. [PMID: 24216032 PMCID: PMC4442633 DOI: 10.1177/0956462413495820] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
HIV-infected individuals have poor responses to hepatitis B vaccine and may have decreased durability of post-vaccination immunity. Retrospective chart review was conducted for HIV-1 positive individuals aged ≥18 years who received hepatitis B vaccine at an urban HIV clinic. A total of 309 patients completed three doses and 178 had post-vaccine serology testing after the third dose. In multivariate analysis, time between the third dose and the first post-vaccine serology testing at 180-359 days (OR = 0.077, p = 0.049) and at ≥360 days (OR = 0.065, p = 0.019) were associated with poor vaccine responses. A significant decrease in seropositivity appeared as early as 180 days after the third vaccine dose, suggesting a rapid loss of vaccine-acquired hepatitis B surface antibody in HIV-infected persons. Our findings suggest that hepatitis B surface antibody should be tested at 6 to 12 months after completing primary vaccine series in order to detect early secondary vaccine failure.
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35
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Rowley K, Payne BAI, Schmid ML. Determinants of response to repeat hepatitis B vaccination in HIV-infected prior non-responders. J Infect 2014; 69:98-9. [PMID: 24583049 DOI: 10.1016/j.jinf.2014.02.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 02/17/2014] [Accepted: 02/22/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Kate Rowley
- Department of Infection and Tropical Medicine, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK.
| | - Brendan A I Payne
- Newcastle Microbiology Services, Freeman Hospital, Newcastle-upon-Tyne, UK; Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, UK.
| | - Matthias L Schmid
- Department of Infection and Tropical Medicine, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK.
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36
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Abstract
Community-acquired pneumonia continues to be an important complication of HIV infection. Rates of pneumonia decrease with the use of antiretroviral therapy but continue to be higher than in HIV uninfected individuals. Risk factors for pneumonia include low blood CD4+ count, unsuppressed plasma HIV load, smoking, injection drug use and renal impairment. Immunization against Streptococcus pneumoniae and smoking cessation can reduce this risk. It is unclear whether newly reported viral respiratory pathogens (such as the Middle East respiratory syndrome coronavirus, will be more of a problem in HIV-infected individuals than the general population.
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Affiliation(s)
- James Brown
- Respiratory & HIV Medicine, University College London, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
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37
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Zahlanie YC, Hammadi MM, Ghanem ST, Dbaibo GS. Review of meningococcal vaccines with updates on immunization in adults. Hum Vaccin Immunother 2014; 10:995-1007. [PMID: 24500529 PMCID: PMC4896590 DOI: 10.4161/hv.27739] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 12/31/2013] [Accepted: 01/06/2014] [Indexed: 11/19/2022] Open
Abstract
Meningococcal disease is a serious and global life-threatening disease. Six serogroups (A, B, C, W-135, X, and Y) account for the majority of meningococcal disease worldwide. Meningococcal polysaccharide vaccines were introduced several decades ago and have led to the decline in the burden of disease. However, polysaccharide vaccines have several limitations, including poor immunogenicity in infants and toddlers, short-lived protection, lack of immunologic memory, negligible impact on nasopharyngeal carriage, and presence of hyporesponsiveness after repeated doses. The chemical conjugation of plain polysaccharide vaccines has the potential to overcome these drawbacks. Meningococcal conjugate vaccines include the quadrivalent vaccines (MenACWY-DT, MenACWY-CRM, and MenACWY-TT) as well as the monovalent A and C vaccines. These conjugate vaccines were shown to elicit strong immune response in adults. This review addresses the various aspects of meningococcal disease, the limitations posed by polysaccharide vaccines, the different conjugate vaccines with their immunogenicity and reactogenicity in adults, and the current recommendations in adults.
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Affiliation(s)
- Yorgo C Zahlanie
- Center for Infectious Diseases Research; Division of Pediatric Infectious Diseases; Department of Pediatrics and Adolescent Medicine; American University of Beirut Medical Center; Beirut, Lebanon
| | - Moza M Hammadi
- Center for Infectious Diseases Research; Division of Pediatric Infectious Diseases; Department of Pediatrics and Adolescent Medicine; American University of Beirut Medical Center; Beirut, Lebanon
| | - Soha T Ghanem
- Department of Pediatrics; Makassed General Hospital; Beirut, Lebanon
| | - Ghassan S Dbaibo
- Center for Infectious Diseases Research; Division of Pediatric Infectious Diseases; Department of Pediatrics and Adolescent Medicine; American University of Beirut Medical Center; Beirut, Lebanon
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Chaiklang K, Wipasa J, Chaiwarith R, Praparattanapan J, Supparatpinyo K. Comparison of immunogenicity and safety of four doses and four double doses vs. standard doses of hepatitis B vaccination in HIV-infected adults: a randomized, controlled trial. PLoS One 2013; 8:e80409. [PMID: 24265819 PMCID: PMC3827227 DOI: 10.1371/journal.pone.0080409] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 09/26/2013] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND HBV vaccination is recommended in HIV-infected adults with CD4+ cell count >200/mm(3) although the efficacy is only 33.3% -65%. We conducted a randomized, controlled trial to evaluate the efficacy and safety of three regimens of HBV vaccination at Chiang Mai University Hospital, Thailand. METHODS From February 4, 2011 to May 4, 2012, 132 HIV-infected adults with CD4+ cell counts >200 cells/mm(3), undetectable plasma HIV-1 RNA, and negative for all HBV markers were randomly assigned to receive one of three recombinant vaccine (Hepavax-Gene(®) Berna, Korea) regimens: 20 μg IM at months 0, 1, and 6 (Standard doses group, n=44), 20 μg IM at months 0, 1, 2, 6 (four doses group, n=44), or 40 μg IM at months 0, 1, 2, and 6 (four double doses group, n=44). The primary outcomes were to compare the immunogenicity and safety between the four-doses groups with the Standard doses group. RESULTS At months 7 and 12, the percentages of responders (anti-HBs ≥ 10 mIU/mL) were 88.6% and 70.4% in the Standard doses group, 93.2% and 86.4% in the four doses group, (P=0.713 and 0.119), and 95.4% and 88.6% in the four double doses group, (P=0.434 and 0.062), respectively. Factors associated with a high titer level (anti-HBs ≥ 100 mIU/mL) were vaccination schedule and younger age. The most common adverse event was pain at the injection site (42.4%); this was significantly more frequent in the four double doses group compared to the Standard doses group. No serious adverse events were observed. CONCLUSIONS In Northern Thailand, the standard three-doses HBV vaccination in HIV-infected adults with CD4+ cell counts >200 cells/mm(3) and undetectable plasma HIV-1 RNA is highly effective. Although regimens of four injections of either standard or double doses could not significantly increase the response rate, these regimens may induce higher levels of antibody to the virus. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov; NCT1289106; http://clinicaltrials.gov/ct2/show/NCT01289106.
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Affiliation(s)
- Kanokporn Chaiklang
- Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Jiraprapa Wipasa
- Research Institutes for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Romanee Chaiwarith
- Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Khuanchai Supparatpinyo
- Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Research Institutes for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- * E-mail:
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Mahil SK, Fleming J, Robson A, Sarkany R. Measles in a previously vaccinated human immunodeficiency virus-positive adult. Clin Exp Dermatol 2013; 39:117-8. [PMID: 24341480 DOI: 10.1111/ced.12238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2013] [Indexed: 12/01/2022]
Affiliation(s)
- S K Mahil
- Department of Dermatology, St. John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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40
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Respiratory infections in HIV-infected adults: epidemiology, clinical features, diagnosis and treatment. Curr Opin Pulm Med 2013; 19:238-43. [PMID: 23422413 DOI: 10.1097/mcp.0b013e32835f1b5c] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Using the evidence published over the last 2 years, this review discusses the epidemiology, diagnosis, treatment and prevention of HIV-related pulmonary infections other than mycobacterial disease. RECENT FINDINGS Longstanding, vertically acquired and apparently stable HIV infection is associated with significant and symptomatic small airways disease in African adolescents. The use of population-based pneumococcal vaccination in children is changing the severity and serotypes associated with HIV-related pneumococcal disease. Data on the use of blood 1,3,β-D-glucan show it has promise as a rule-out test for Pneumocystis pneumonia (PCP). SUMMARY With widespread antiretroviral medication usage, the pattern of HIV-associated pulmonary disease is changing. Whereas opportunistic infections such as PCP still occur in people not using antiretroviral therapy (ART), HIV-related infections are similar to those present in the general population. Chronic lung disease is more prevalent, leading to its own infectious complications. The use of specific immunizations against infections is important, though their precise benefit with concomitant widespread ART and population-based vaccination programmes in the non-HIV community is undetermined.
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Kourkounti S, Papaizos V, Leuow K, Kordosis T, Antoniou C. Hepatitis A Vaccination and Immunological Parameters in HIV-Infected Patients. Viral Immunol 2013; 26:357-63. [DOI: 10.1089/vim.2012.0100] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Sofia Kourkounti
- Department of Dermatology and Venereology (AIDS Unit), A. Sygros Hospital, Athens, Greece
| | - Vassilios Papaizos
- Department of Dermatology and Venereology (AIDS Unit), A. Sygros Hospital, Athens, Greece
| | - Kirsten Leuow
- Department of Dermatology and Venereology (AIDS Unit), A. Sygros Hospital, Athens, Greece
| | - Theodoros Kordosis
- Department of Pathophysiology (AIDS Unit), Laikon General Hospital, Athens, Greece
| | - Christina Antoniou
- Department of Dermatology and Venereology (AIDS Unit), A. Sygros Hospital, Athens, Greece
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Patel D, Simons H. Yellow fever vaccination: is one dose always enough? Travel Med Infect Dis 2013; 11:266-73. [PMID: 24074827 DOI: 10.1016/j.tmaid.2013.08.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Revised: 08/29/2013] [Accepted: 08/29/2013] [Indexed: 11/19/2022]
Abstract
In March 2013, the World Health Organization (WHO) Strategic Advisory Group of Experts on Immunisation (SAGE) considered a number of issues in order to update the WHO Position Paper on Yellow Fever (2003). A key conclusion of this review was that a single dose of yellow fever (YF) vaccine appears to confer life-long protection against YF disease, and that a booster dose of YF vaccine is not needed to maintain immunity. While the efficacy of YF vaccine in the majority of vaccine recipients is not in doubt, the WHO announcement is somewhat surprising as there are some limitations in the evidence base, but more importantly, this announcement is not accompanied by any imminent change in the International Health Regulations 2005. The tension between what is considered best clinical practice and the law will be difficult to reconcile for many health professionals, travellers, and the travel industry, in an area of travel medicine that is already subject to debate and confusion. This commentary reviews the recent WHO announcement, and considers the practical implications for health professionals providing YF vaccine to international travellers.
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Affiliation(s)
- Dipti Patel
- National Travel Health Network and Centre, London, UK; Foreign and Commonwealth Office, London, UK; Centre for Occupational and Environmental Health, School of Medicine, The University of Manchester, Manchester, UK.
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Rock C, Barra ED, Sadlier C, Kelly S, Dowling C, McNally C, Bergin C. Impact of a new vaccine clinic on hepatitis B vaccine completion and immunological response rates in an HIV-positive cohort. J Infect Public Health 2013; 6:173-8. [DOI: 10.1016/j.jiph.2012.11.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 10/27/2012] [Accepted: 11/07/2012] [Indexed: 01/21/2023] Open
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Collini PJ, Kuijper E, Dockrell DH. Clostridium Difficile Infection in Patients with HIV/AIDS. Curr HIV/AIDS Rep 2013; 10:273-82. [DOI: 10.1007/s11904-013-0162-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Strategies to increase responsiveness to hepatitis B vaccination in adults with HIV-1. THE LANCET. INFECTIOUS DISEASES 2013; 12:966-76. [PMID: 23174382 DOI: 10.1016/s1473-3099(12)70243-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
HIV and hepatitis B virus co-infection leads to substantially increased morbidity and mortality compared with either infection alone. Immunisation with hepatitis B virus vaccine is the most effective way to prevent the infection in people with HIV; however, these patients have decreased vaccine responses and a short duration of protection compared with immunocompetent individuals. Control of HIV replication with highly active antiretroviral therapy and increased CD4 cell counts are associated with improved immune responses to hepatitis B vaccination. New vaccination strategies, such as increased vaccine dose, use of the intradermal route, and addition of adjuvants, could improve response rates in adults with HIV.
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Rock C, Sadlier C, Fitzgerald J, Kelleher M, Dowling C, Kelly S, Bergin C. Epidemiology of invasive pneumococcal disease and vaccine provision in a tertiary referral center. Eur J Clin Microbiol Infect Dis 2013; 32:1135-41. [PMID: 23525795 DOI: 10.1007/s10096-013-1859-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 03/06/2013] [Indexed: 09/05/2023]
Abstract
Invasive pneumococcal disease (IPD) has an all-cause mortality of 5-35 % in the developed world. Pneumococcal vaccination is recommended for at-risk groups, including those infected with human immunodeficiency virus (HIV) and those over 65 years of age. However, adherence to vaccination guidelines is low. We reviewed all cases of IPD in our tertiary referral hospital from 2006 to 2010. IPD was defined as the isolation of Streptococcus pneumoniae from a normally sterile site with a compatible clinical syndrome. Demographics, risk factors, susceptibilities, pneumococcal serotype, mortality, and vaccination status for each patient were analyzed. There were 127 IPD episodes in 122 patients. The overall case fatality rate was 21.2 %. Seventy-two percent of the patients had two or more risk factors that should have prompted pneumococcal vaccination. However, the overall pneumococcal vaccination provision was only 9 %: 64.6 % of all typed isolates were contained in the pneumococcal polysaccharides vaccine 23 (PPV23), 48.8 % in the 7-valent pneumococcal conjugate vaccine (PCV7), and 60.1 % in PCV13. All isolates were fully sensitive to penicillin and cefotaxime. Recurrent IPD was seen in 11 % of the HIV-infected patients, highlighting a particular at-risk group. IPD has a high mortality rate. There is low vaccine provision in our study, although most IPD patients had risk factors that should have prompted vaccination. HIV-positive people are particularly at risk; vaccinating those with persisting CD4 counts less than 200 cells/mm(3) and the use of "prime-boost" strategies may decrease incidence in the future. Newer models of care such as a dedicated vaccine clinic as described in this study may help increase vaccine provision and uptake.
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Affiliation(s)
- C Rock
- Department of Infectious Diseases, University of Maryland, 725 West Lombard Street, Baltimore, MD 21201, USA.
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Croucher AP, Jose S, McDonald S, Foster C, Fidler S. Sexual and reproductive health in a UK cohort of young adults perinatally infected with HIV. Sex Transm Infect 2013; 89:392-4. [PMID: 23434788 DOI: 10.1136/sextrans-2012-050831] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To assess sexual health and behaviour outcomes of young adults with perinatally acquired HIV-1 (PaHIV), and audit sexual health interventions against published standards of care. METHODS Retrospective case note audit of 16-25-year-olds with PaHIV attending a dedicated transition clinic from January 2005 to 2011. RESULTS Fifty-two young adults, 31 women, median age 20 years. 41 were sexually active; median age of coitarche 16 years. Median number of lifetime partners was 3.5, and five reported non-consensual sex. All had a sexually transmitted infection (STI) screen; 6 were diagnosed with an STI, genital warts (human papilloma virus) most frequently. The median interval from coitarche to first STI screen was 2 years. The pregnancy incidence was 103 per 1000 person years. 18/25 (72%) sexually active women had a cervical smear, four had colposcopy. All patients had hepatitis B virus (HBV) serology. 47 had not been vaccinated against HBV prior to transition. 23 completed HBV vaccination of which 11 had surface antibody >100 IU/ml at 1 year. CONCLUSIONS The majority of our cohort was sexually active while still under the care of paediatric health services. Cervical screening and hepatitis B vaccination rates fell short of audit standards. Vaccination for hepatitis B should be considered prior to transfer of care to adult HIV services.
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Affiliation(s)
- Adam P Croucher
- Jefferiss Wing, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK.
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Kourkounti S, Mavrianou N, Paparizos VA, Kyriakis K, Hatzivassiliou M, Kordosis T, Katsambas A. Immune response to hepatitis A vaccination in HIV-infected men in Greece. Int J STD AIDS 2013; 23:464-7. [PMID: 22843998 DOI: 10.1258/ijsa.2011.011297] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
HIV-infected patients are at increased risk for acquiring hepatitis A virus (HAV) infection. We evaluated the seroconversion rate (anti-HAV antibodies ≥ 20 mIU/ml) and the geometric mean antibody titres (GMTs) in a group of 351 HIV infected men, who had received two doses of a hepatitis A vaccine. We analysed blood samples collected at one, six, 12 and 18 months following the administration of the second dose of the vaccine. The seroconversion rate one month after the second dose of the vaccine was 74.4% (260/351). At month 18 after the end of vaccination, 56.1% of the subjects remained seropositive. GMTs were 315, 203, 153 and 126 mIU/ml at months 1, 6, 12, and 18, respectively. Logistic regression revealed that the CD4 count is the only factor affecting response to vaccination (P = 0.019). A higher response rate and higher GMTs were observed in patients with CD4 counts ≥ 500 cells/mm(3) (76.6%) than in patients with CD4 counts 200-499 cells/mm(3). In conclusion, even in patients with near-normal CD4 counts, the response to the hepatitis A vaccine is impaired.
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Affiliation(s)
- S Kourkounti
- Department of Dermatology and Venereology, (AIDS Unit) 'A. Sygros' Hospital, Greece.
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Abstract
This article reviews the normal immune response to vaccines. It describes the effect of different immunosuppressive therapies (glucocorticoids, inhibitors of calcineurin and mTOR, azathioprine, mycophenolate acid, methotrexate, depleting and nondepleting monoclonal antibodies, and tumor necrosis factor antagonists) on critical steps in the cellular and humoral immune responses to vaccines. The impact of age-related involution of thymus and bone marrow on the immune reconstitution in allogeneic hematopoietic cell transplant recipients and human immunodeficiency virus is covered. A practical approach to vaccinating and preparing travelers with severe immunosuppression is proposed.
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Affiliation(s)
- L G Visser
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, Netherlands.
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Llenas-García J, Rubio R, Hernando A, Arrazola P, Pulido F. Do HIV-positive adult immigrants need to be screened for measles–mumps–rubella and varicella zoster virus immunization? AIDS Care 2012; 25:980-9. [DOI: 10.1080/09540121.2012.748881] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Jara Llenas-García
- HIV Unit, Instituto de Investigación Hospital 12 de Octubre (i + 12), Universidad Complutense, Madrid, Spain
| | - Rafael Rubio
- HIV Unit, Instituto de Investigación Hospital 12 de Octubre (i + 12), Universidad Complutense, Madrid, Spain
| | - Asunción Hernando
- Medical Specialties Department, European University of Madrid, Madrid, Spain
| | - Pilar Arrazola
- Preventive Medicine Department, Instituto de Investigación Hospital 12 de Octubre (i + 12), Universidad Complutense, Madrid, Spain
| | - Federico Pulido
- HIV Unit, Instituto de Investigación Hospital 12 de Octubre (i + 12), Universidad Complutense, Madrid, Spain
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