Altered immunological reactivity in HIV-1-exposed uninfected neonates

Hygino, Joana; Lima, Patrícia G.; Filho, Renato G.S.; Silva, Agostinho A.L.; Saramago, Carmen S.M.; Andrade, Regis M.; Andrade, Daniel M.; Andrade, Arnaldo F.B.; Brindeiro, Rodrigo M.; Tanuri, Amílcar; Bento, Cleonice A.M.

doi:10.1016/j.clim.2008.01.020

Cited by 49 publications

(41 citation statements)

References 52 publications

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“…The underlying reason(s) for this phenomenon are still unclear but are possibly multifactorial; severity of maternal HIV disease (13), avoidance of breastfeeding (14)(15)(16), and differences in microbial exposures (17) have all been postulated. Furthermore, exposure to HIV itself (18), as well as to antiretroviral drugs for VTP, may also directly impact the HEU infant's immune system (19,20). Suboptimal response to vaccination thus has been suggested to contribute to the increased infectious burden of HEU.…”

mentioning

confidence: 99%

Antibody Responses to Vaccination among South African HIV-Exposed and Unexposed Uninfected Infants during the First 2 Years of Life

Reikie

Naidoo

Ruck

et al. 2013

Clin Vaccine Immunol

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e HIV-exposed but uninfected (HEU) infants born to HIV-infected mothers from areas in the world with a high burden of infectious disease suffer higher infectious morbidity and mortality than their HIV unexposed uninfected (HUU) peers. Vaccination provides protection from infection. The possibility exists that altered response to vaccination contributes to the higher rate of infection in HEU than in HUU infants. While short-term, cross-sectional studies support this notion, it is unclear whether or not HEU infants develop long-term protective immune responses following the WHO extended program on immunization (EPI).Vaccine-specific antibody responses were compared between HEU and HUU infants from 2 weeks until 2 years of age in a longitudinal South African cohort. Total IgG and antibodies specific for Bordetella pertussis, Haemophilus influenzae type b (Hib), tetanus toxoid, hepatitis B virus (HepB), and measles virus were measured at multiple time points throughout the first 2 years of life. Prevaccine antibodies (maternal antibodies passively acquired) specific for tetanus were lower in HEU than in HUU infants, while prevaccine antibodies to HepB were higher in HEU than in HUU infants. Both groups responded similarly to tetanus, Hib, and HepB vaccination. HEU demonstrated stronger pertussis vaccine responses, developing protective titers 1 year earlier than HUU patients, and maintained higher anti-tetanus titers at 24 months of age. Vaccine-induced antibodies to measles virus were similar in both groups at all time points. Our results suggest that the current EPI vaccination program as practiced in South Africa leads to the development of vaccine-specific antibody responses that are equivalent in HEU and HUU infants. However, our data also suggest that a large fraction of both HEU and HUU South African infants have antibody titers for several infectious threats that remain below the level of protection for much of their first 2 years of life.

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confidence: 99%

Antibody Responses to Vaccination among South African HIV-Exposed and Unexposed Uninfected Infants during the First 2 Years of Life

Reikie

Naidoo

Ruck

et al. 2013

Clin Vaccine Immunol

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“…Comparatively few studies have also suggested that HIV-exposed (but uninfected) infants may have impaired immune responses following vaccination (2,3). HIV proteins from an infected mother can cross the placenta and induce a state of persistent immune activation in the fetus, which may impair immune system development (4). Maternal receipt of antiretrovirals can also alter the placental barrier and change cytokine expression in the fetus (5).…”

mentioning

confidence: 99%

Effect of Multivitamin Supplementation on Measles Vaccine Response among HIV-Exposed Uninfected Tanzanian Infants

Sudfeld

Duggan

Histed

et al. 2013

Clin Vaccine Immunol

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Immunization and nutritional interventions are mainstays of child health programs in sub-Saharan Africa, yet few published data exist on their interactions. HIV-exposed (but uninfected) infants enrolled in a randomized placebo-controlled trial of multivitamin supplements (vitamins B complex, C, and E) conducted in Tanzania were sampled for an assessment of measles IgG quantity and avidity at 15 to 18 months. Infants were vaccinated between 8.5 and 12 months of age, and all mothers received high-dose multivitamins as the standard of care. Of 201 HIV-exposed infants who were enrolled, 138 (68.7%) were seropositive for measles. There were no effects of infant multivitamin supplementation on measles seroconversion proportions, IgG concentrations, or IgG avidity (P > 0.05). The measles seroconversion proportion was greater for HIV-exposed infants vaccinated at 10 to 11 months of age than for those vaccinated at 8.5 to 10 months (P ‫؍‬ 0.032) and greater for infants whose mothers had a CD4 T-cell count of <200 cells/l than for infants whose mothers had a CD4 T-cell count of >350 cells/l (P ‫؍‬ 0.039). Stunted infants had a significantly decreased IgG quantity compared to nonstunted infants (P ‫؍‬ 0.012). As for measles avidity, HIV-exposed infants vaccinated at 10 to 11 months had increased antibody avidity compared to those vaccinated at 8.5 to 10 months (P ‫؍‬ 0.031). Maternal CD4 T-cell counts of <200 cells/l were associated with decreased avidity compared to counts of >350 cells/l (P ‫؍‬ 0.047), as were lower infant height-for-age z-scores (P ‫؍‬ 0.016). Supplementation with multivitamins containing B complex, C, and E does not appear to improve measles vaccine responses for HIV-exposed infants. Studies are needed to better characterize the impact of maternal HIV disease severity on the immune system development of HIV-exposed infants and the effect of malnutrition interventions on vaccine responses. (This study has been registered at ClinicalTrials.gov under registration no. NCT00197730.)

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“…Proteins from HIV are able to cross the placental barrier and cause a state of immune activation in the offspring (14). Also, the antiretroviral (ARV) prophylaxis of vertical transmission can act on the placental environment, causing changes in cytokine expression (9).…”

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confidence: 99%

Impaired Humoral Response to Vaccines among HIV-Exposed Uninfected Infants

Abramczuk

Mazzola

Moreno

et al. 2011

Clin. Vaccine Immunol.

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Little is known about the vaccine protective response for infants born from HIV-infected mothers. We evaluated the antibody response to hepatitis B, tetanus, and diphtheria vaccine in vertically HIV-exposed uninfected infants and compared them to those of control infants not exposed to the virus. The quantitative determination of specific neutralizing antibodies against hepatitis B, diphtheria, and tetanus were performed blindly on serum samples. The results showed that 6.7% of the HIV-exposed uninfected individuals were nonresponders to hepatitis B vaccine (anti-HBs titer, <10 mIU/ml), and 64.4% were very good responders (anti-HBs titer, >1,000 mIU/ml), whereas only 3.6% of the nonexposed infants were nonresponders ( 2 ‫؍‬ 10.93; 1 df). The HIV-exposed uninfected infants showed protective titers for diphtheria and tetanus but lower geometric mean anti-tetanus titers compared to those of the HIV-unexposed infants. Our data point to the necessity of evaluating vaccine immune responses in these children and reinforced that alterations in lymphocyte numbers and functions reported for newborns from HIV-infected mothers interfere with the vaccine response.

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Altered immunological reactivity in HIV-1-exposed uninfected neonates

Cited by 49 publications

References 52 publications

Antibody Responses to Vaccination among South African HIV-Exposed and Unexposed Uninfected Infants during the First 2 Years of Life

Antibody Responses to Vaccination among South African HIV-Exposed and Unexposed Uninfected Infants during the First 2 Years of Life

Effect of Multivitamin Supplementation on Measles Vaccine Response among HIV-Exposed Uninfected Tanzanian Infants

Impaired Humoral Response to Vaccines among HIV-Exposed Uninfected Infants

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