CD4/CD8 Ratio Predicts Yellow Fever Vaccine-Induced Antibody Titers in Virologically Suppressed HIV-Infected Patients

Avelino‐Silva, Vivian Iida; Miyaji, Karina Takesaki; Mathias, Augusto; Costa, Da; Dias, Juliana Zanatta de Carvalho; Lima, Sheila Barbosa de; Simões, Marisol; Freire, Marcos S.; Caiaffa-Filho, Hélio H.; Hong, Marisa Ailin; Lopes, Marta Heloísa; Sartori, Ana Marli Christovam; Kallas, Esper G.

doi:10.1097/qai.0000000000000845

Cited by 35 publications

(30 citation statements)

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“…In our study, despite the elevated CD4 T cell count and high proportion of ART-suppressed individuals, HIV status was still associated with lower persistence of YF-specific NAb titers following an apparently adequate initial immunogenicity. Our results are consistent with prior publications suggesting that HIV-infected subjects still present lower responses to vaccines [1, 6, 16]. In addition, while the START and TEMPRANO trials demonstrated that earlier ART initiation dramatically reduces the risk of infectious outcomes, there was still a substantial risk of infectious outcomes in the immediate ART arms [36, 37].…”

Section: Discussionsupporting

confidence: 92%

“…NAb titers against YF virus were measured by Plaque Reduction Neutralization Test (PRNT) performed at Virologic Technology Laboratory of Bio-Manguinhos (LATEV, FIOCRUZ, Rio de Janeiro) as previously described [16]. …”

Section: Methodsmentioning

confidence: 99%

“…We calculated sample size based on the impact of HIV status on titers of YF-specific NAb in the first 3 months following vaccination, using estimates of effect size and standard deviation from a prior study published by our group [16]. Since the analysis plan included mixed models for repeated outcomes, we assumed a 20% reduction in error variance and estimated a final sample of 33 participants per group using conventional means comparison.…”

Section: Methodsmentioning

confidence: 99%

“…More recently, studies including patients with early initiation of ART have suggested a negative effect of persistent immune activation on responses to Influenza vaccine [13, 14], Neisseria meningitis vaccine [15] and YFV [16, 17] in both HIV-infected and–uninfected individuals. This is consistent with previous studies that demonstrate excessive immune activation and inflammation predict residual morbidity and mortality in treated HIV-infected patients [18–20].…”

Section: Introductionmentioning

confidence: 99%

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CD4/CD8 Ratio and KT Ratio Predict Yellow Fever Vaccine Immunogenicity in HIV-Infected Patients

et al. 2016

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BackgroundHIV-infected individuals have deficient responses to Yellow Fever vaccine (YFV) and may be at higher risk for adverse events (AE). Chronic immune activation–characterized by low CD4/CD8 ratio or high indoleamine 2,3-dioxygenase-1 (IDO) activity—may influence vaccine response in this population.MethodsWe prospectively assessed AE, viremia by the YFV virus and YF-specific neutralizing antibodies (NAb) in HIV-infected (CD4>350) and -uninfected adults through 1 year after vaccination. The effect of HIV status on initial antibody response to YFV was measured during the first 3 months following vaccination, while the effect on persistence of antibody response was measured one year following vaccination. We explored CD4/CD8 ratio, IDO activity (plasma kynurenine/tryptophan [KT] ratio) and viremia by Human Pegivirus as potential predictors of NAb response to YFV among HIV-infected participants with linear mixed models.Results12 HIV-infected and 45-uninfected participants were included in the final analysis. HIV was not significantly associated with AE, YFV viremia or NAb titers through the first 3 months following vaccination. However, HIV–infected participants had 0.32 times the NAb titers observed for HIV-uninfected participants at 1 year following YFV (95% CI 0.13 to 0.83, p = 0.021), independent of sex, age and prior vaccination. In HIV-infected participants, each 10% increase in CD4/CD8 ratio predicted a mean 21% higher post-baseline YFV Nab titer (p = 0.024). Similarly, each 10% increase in KT ratio predicted a mean 21% lower post-baseline YFV Nab titer (p = 0.009). Viremia by Human Pegivirus was not significantly associated with NAb titers.ConclusionsHIV infection appears to decrease the durability of NAb responses to YFV, an effect that may be predicted by lower CD4/CD8 ratio or higher KT ratio.

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Section: Discussionsupporting

confidence: 92%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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CD4/CD8 Ratio and KT Ratio Predict Yellow Fever Vaccine Immunogenicity in HIV-Infected Patients

et al. 2016

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“…121 If travel to an endemic area cannot be avoided, yellow fever vaccination can be considered in asymptomatic HIV-infected individuals with CD4 T-cell lymphocyte counts 200 cells/ mm 3 . 121 …”

Section: Yellow Fever Vaccinationmentioning

confidence: 99%

Recommended immunization schedules for adults: Clinical practice guidelines by the Escmid Vaccine Study Group (EVASG), European Geriatric Medicine Society (EUGMS) and the World Association for Infectious Diseases and Immunological Disorders (WAidid)

Esposito

Bonanni

Maggi

et al. 2016

Human Vaccines & Immunotherapeutics

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Rapid population aging has become a major challenge in the industrialized world and progressive aging is a key reason for making improvement in vaccination a cornerstone of public health strategy. An increase in age-related disorders and conditions is likely to be seen in the near future, and these are risk factors for the occurrence of a number of vaccine-preventable diseases. An improvement in infectious diseases prevention specifically aimed at adults and the elderly can therefore also decrease the burden of these chronic conditions by reducing morbidity, disability, hospital admissions, health costs, mortality rates and, perhaps most importantly, by improving the quality of life. Among adults, it is necessary to identify groups at increased risk of vaccine-preventable diseases and highlight the epidemiological impact and benefits of vaccinations using an evidence-based approach. This document provides clinical practice guidance on immunization for adults in order to provide recommendations for decision makers and healthcare workers in Europe. Although immunization is considered one of the most impactful and cost-effective public health measures that can be undertaken, vaccination coverage rates among adults are largely lower than the stated goal of 95% among adults, and stronger efforts are needed to increase coverage in this population. Active surveillance of adult vaccine-preventable diseases, determining the effectiveness of the vaccines approved for marketing in the last 5 y, the efficacy and safety of vaccines in immunocompromised patients, as well as in pregnant women, represent the priorities for future research.

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Short Oligopeptide T-Cell Epitopes in HIV-1/AIDS Vaccine Development: Current Status, Design, Promises and Challenges

Kangueane

Viswapoorani

Nilofer

et al. 2017

Global Virology II - HIV and NeuroAIDS

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CD4/CD8 Ratio Predicts Yellow Fever Vaccine-Induced Antibody Titers in Virologically Suppressed HIV-Infected Patients

Cited by 35 publications

References 51 publications

CD4/CD8 Ratio and KT Ratio Predict Yellow Fever Vaccine Immunogenicity in HIV-Infected Patients

CD4/CD8 Ratio and KT Ratio Predict Yellow Fever Vaccine Immunogenicity in HIV-Infected Patients

Recommended immunization schedules for adults: Clinical practice guidelines by the Escmid Vaccine Study Group (EVASG), European Geriatric Medicine Society (EUGMS) and the World Association for Infectious Diseases and Immunological Disorders (WAidid)

Short Oligopeptide T-Cell Epitopes in HIV-1/AIDS Vaccine Development: Current Status, Design, Promises and Challenges

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