Immunogenicity of a Monovalent 2009 Influenza A (H1N1) Vaccine in an Immunocompromised Population: A Prospective Study Comparing HIV-Infected Adults with HIV-Uninfected Adults

Crum-Cianflone, Nancy F.; Eberly, Lynn E.; Duplessis, Chris; Maguire, Jason D.; Ganesan, Anuradha; Faix, Dennis J.; Defang, Gabriel; Bai, Yun; Iverson, Erik; Lalani, Tahaniyat; Whitman, Timothy J.; Blair, Patrick J.; Brandt, Carolyn; Macalino, Grace; Burgess, Timothy

doi:10.1093/cid/ciq019

Cited by 90 publications

(76 citation statements)

References 39 publications

(53 reference statements)

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“…Studies in patients infected with HIV-1 have shown that anti-influenza-specific antibody responses correlated with the CD4 T cell count 34 . Indeed, HIV-1 infected patients generated poorer responses to monovalent influenza A H1N1/2009 vaccine compared to healthy subjects 35,36 .…”

Section: Discussionmentioning

confidence: 99%

Glucocorticoid: Major Factor for Reduced Immunogenicity of 2009 Influenza A (H1N1) Vaccine in Patients with Juvenile Autoimmune Rheumatic Disease

Aikawa

Campos²,

Silva³

et al. 2011

J Rheumatol

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Objective.To assess the immunogenicity and safety of non-adjuvanted influenza A H1N1/2009 vaccine in patients with juvenile autoimmune rheumatic disease (ARD) and healthy controls, because data are limited to the adult rheumatologic population.Methods.A total of 237 patients with juvenile ARD [juvenile systemic lupus erythematosus (JSLE), juvenile idiopathic arthritis (JIA), juvenile dermatomyositis (JDM), juvenile scleroderma, and vasculitis] and 91 healthy controls were vaccinated. Serology for anti-H1N1 was performed by hemagglutination inhibition assay. Seroprotection rate, seroconversion rate, and factor-increase in geometric mean titer (GMT) were calculated. Adverse events were evaluated.Results.Age was comparable in patients and controls (14.8 ± 3.0 vs 14.6 ± 3.7 years, respectively; p = 0.47). Three weeks after immunization, seroprotection rate (81.4% vs 95.6%; p = 0.0007), seroconversion rate (74.3 vs 95.6%; p < 0.0001), and the factor-increase in GMT (12.9 vs 20.3; p = 0.012) were significantly lower in patients with juvenile ARD versus controls. Subgroup analysis revealed reduced seroconversion rates in JSLE (p < 0.0001), JIA (p = 0.008), JDM (p = 0.025), and vasculitis (p = 0.017). Seroprotection (p < 0.0001) and GMT (p < 0.0001) were decreased only in JSLE. Glucocorticoid use and lymphopenia were associated with lower seroconversion rates (60.4 vs 82.9%; p = 0.0001; and 55.6 vs 77.2%; p = 0.012). Multivariate logistic regression including diseases, lymphopenia, glucocorticoid, and immunosuppressants demonstrated that only glucocorticoid use (p = 0.012) remained significant.Conclusion.This is the largest study to demonstrate a reduced but adequate immune response to H1N1 vaccine in patients with juvenile ARD. It identified current glucocorticoid use as the major factor for decreased antibody production. The short-term safety results support its routine recommendation for patients with juvenile ARD. ClinicalTrials.gov; NCT01151644.

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Section: Discussionmentioning

confidence: 99%

Glucocorticoid: Major Factor for Reduced Immunogenicity of 2009 Influenza A (H1N1) Vaccine in Patients with Juvenile Autoimmune Rheumatic Disease

Aikawa

Campos²,

Silva³

et al. 2011

J Rheumatol

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“…In fact, several studies on the efficacy of MF59-adjuvanted 2009 pandemic A/H1N1 influenza vaccine (A/H1N1/Cal/09) suggested a lower rate of influenza seroconversion in HIV-infected individuals (36.4-69%) as compared with healthy donors ( > 79%), [18][19][20] even in patients with high CD4 T cell counts. 21 In contrast, other studies reported a good antibody response in successfully HAART-treated HIV patients. 22,23 However, all these studies addressed the humoral response only, and no information about the ability of pandemic vaccine to elicit a strain-specific and cross-reactive T cell response is available in HIV-infected individuals.…”

Section: Introductionmentioning

confidence: 90%

Cellular and Humoral Immune Responses to Pandemic Influenza Vaccine in Healthy and in Highly Active Antiretroviral Therapy-Treated HIV Patients

Agrati

Gioia

Castilletti

et al. 2012

AIDS Research and Human Retroviruses

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“…7,8 Likewise, 59% of HIV-infected adults with CD4 counts >500 cells/mm 3 responded to the H1N1 vaccine, vs. 80% of uninfected adults. 5 A significantly decreased vaccine response in adults with well-controlled HIV infection has also been demonstrated for the pneumococcal conjugate vaccine 6 and the HBV vaccine series. 4 Chronic infections with viruses such as cytomegalovirus (CMV), HBV, and hepatitis C virus (HCV) have been linked to immune dysfunction and decreased vaccine response in the general population.…”

Section: Introductionmentioning

confidence: 89%

“…Although this improves with cART and CD4 count recovery, the vaccine response in HIV-infected adults with CD4 counts in the normal range remains lower than in uninfected individuals. [4][5][6] For example, 80% of HIV-infected adults with CD4 counts >500 cells/mm 3 achieved seroprotection against hepatitis A virus (HAV) after a 2-dose HAV vaccine series, versus >94% of the general population. 7,8 Likewise, 59% of HIV-infected adults with CD4 counts >500 cells/mm 3 responded to the H1N1 vaccine, vs. 80% of uninfected adults.…”

Section: Introductionmentioning

confidence: 99%

Association of CMV, HBV, or HCV co-infection with vaccine response in adults with well-controlled HIV infection

Troy

Rossheim

Siik

et al. 2016

Human Vaccines & Immunotherapeutics

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Even after CD4 count recovery on antiretroviral therapy, HIV infection is associated with decreased response to most vaccines compared to the general population. Chronic infections with viruses such as cytomegalovirus (CMV), hepatitis B virus (HBV), and hepatitis C virus (HCV), which are more prevalent in HIV-infected populations, have been linked to immune dysfunction and decreased vaccine response in the general population. However, whether co-infection with these other viruses contributes to the decreased vaccine response seen in adults with well-controlled HIV infection is unknown. We conducted a secondary analysis of data and serum from adults with well-controlled HIV infection from an inactivated polio vaccine trial (224 subjects) and a pneumococcal conjugate vaccine study (128 subjects). We evaluated the association of CMV, HBV, or HCV co-infection with post-vaccination antibody levels using both univariate and multivariate analyses, controlling for factors such as age, race, CD4 count, comorbidities, smoking status, and baseline antibody levels. Ninety-three percent, 7%, and 14% of subjects were co-infected with CMV, HBV, and HCV respectively. On both univariate and multivariate analysis, neither CMV nor HCV co-infection were significantly associated with post-vaccination antibody levels to either vaccine. HBV co-infection was significantly associated with post-vaccination antibody concentrations for pneumococcal serotype 7F on univariate analysis and 6A on multivariate analysis, but the association was with higher antibody concentrations. In conclusion, co-infection with CMV, HBV, or HCV does not appear to contribute to the decreased vaccine response seen in adults with well-controlled HIV infection.

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Immunogenicity of a Monovalent 2009 Influenza A (H1N1) Vaccine in an Immunocompromised Population: A Prospective Study Comparing HIV-Infected Adults with HIV-Uninfected Adults

Cited by 90 publications

References 39 publications

Glucocorticoid: Major Factor for Reduced Immunogenicity of 2009 Influenza A (H1N1) Vaccine in Patients with Juvenile Autoimmune Rheumatic Disease

Glucocorticoid: Major Factor for Reduced Immunogenicity of 2009 Influenza A (H1N1) Vaccine in Patients with Juvenile Autoimmune Rheumatic Disease

Cellular and Humoral Immune Responses to Pandemic Influenza Vaccine in Healthy and in Highly Active Antiretroviral Therapy-Treated HIV Patients

Association of CMV, HBV, or HCV co-infection with vaccine response in adults with well-controlled HIV infection

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