Objectives: The aim of this study was to estimate the durability of tetanus toxoid specific seroprotection in a cohort of people with HIV (PWH).Design: A cross-sectional study.Methods: PWH with a last date of tetanus toxoid booster available were identified. Tetanus toxoid specific IgG were detected using commercial ELISA kit. Durability of seroprotection was estimated using a linear regression model and analyzed according to the country of birth. The impact of baseline parameters at the time of vaccination (CD4 þ T cell count, viral load, and antiretroviral therapy) was also assessed.Results: One hundred three individuals were included. The median duration between last tetanus toxoid booster and sampling was 5.6years (IQR 2.6-8.9). Using a linear regression model, half-life of tetanus toxoid specific antibody was estimated at 9.9 years [95% confidence interval (95% CI: 5.5-50)] in the whole cohort. Half-life was reduced in individuals born outside Europe: 4.4 years (95% CI: 2.9-8.5). PWH born outside Europe had lower CD4 þ T cell count at the time of immunization and more frequently a CD4 þ T cell count nadir less than 200 cells/ml before vaccination. Conclusion:PWH born outside Europe have lower half-life of tetanus toxoid specific antibody as compared to previous study performed in the general population. Possible causes include lower nadir or current CD4 þ T cell count or under-immunization status in country of origin before migration. Longer interval of booster vaccination, as recommended in the general population, might not be appropriate in this subgroup of PWH.
Biosciences, and receives honoraria. A.G. receives research grants from AbbVie, UCB and National Psoriasis Foundation. He is co-copyright holder of the Hidradenitis Suppurativa Quality of Life (HiSQOL) scale, and Investigator Global Assessment and Patient Global Assessment instruments for hidradenitis suppurativa.Ethics statement: this research letter did not require institutional review board approval as no human participants were involved in this research.Data availability: data are openly available in a public repository that issues datasets with digital object identifiers.
Objectives: Tetanus is a vaccine-preventable disease. Booster immunization is required in order to induce long-lived tetanus-toxoid (TT) specific antibody response. We investigated the prevalence and risk factors of TT seronegativity in a cohort of people living with HIV (PWH) in Belgium along with the respective performance of vaccine history and a rapid dipstick test (Tetanus Quick Stick Ò or TQS) compared to ELISA testing. Methods: PWH were prospectively enrolled and answered a questionnaire. ELISA was performed on serum or plasma using a commercial kit. A TT antibody level ! 0.15 IU / mL was considered protective. The TQS test was performed on a limited number of subjects. Results: Three-hundred forty-four subjects were included. The prevalence of tetanus seroprotection was 84,9%. Median age was 46.7 and 68% were born outside Belgium. Antiretroviral therapy coverage was almost universal (98.5%). After multivariable analysis, two risk factors were independently associated with TT seronegativity: an education level equivalent or below than secondary school and being born outside Europe. Vaccine history was shown to be unreliable (sensitivity: 43.8%; specificity: 76.5%; positive predictive value: 91.4% and negative predictive value :19.3%). The correlation between vaccine history and tetanus seroprotection was low (kappa coefficient = 0.09). The TQS performances were good (sensitivity 86.4%, specificity 96.0%, positive predictive value 99.3%, negative predictive value 52.17%). The correlation between TQS and tetanus seroprotection was substantial (kappa coefficient = 0.61). Conclusions: In this cohort of PWH with a high proportion of migrants, socio-demographic and educational factors were associated with TT seronegativity while HIV-related factors were not, indicating that vaccine information should be tailored to cultural and educational background. As vaccine history is not reliable, TQS could represent an efficient tool for screening of TT-seronegativity.
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