Measles Immunity at 4.5 Years of Age Following Vaccination at 9 and 15–18 Months of Age Among Human Immunodeficiency Virus (HIV)–infected, HIV-exposed–uninfected, and HIV-unexposed Children

Abstract

BackgroundHuman immunodeficiency virus (HIV)–infected and HIV-exposed–uninfected (HEU) children may be at increased risk of measles infection due to waning of immunity following vaccination. We evaluated persistence of antibodies to measles vaccination at 4.5 years of age in HIV-unexposed, HEU, and HIV-infected children with CD4+ ≥25% previously randomized to immediate antiretroviral therapy (ART) interrupted at 12 months (HIV/Immed-ART-12), 24 months (HIV/Immed-ART-24), or when clinically/immunologically indicated (HIV/Def-ART). The HIV/Def-ART group initiated ART by median 5.8 (interquartile range, 4.4–10.3) months of age.MethodsIn this study, HIV-unexposed (n = 95), HEU (n = 84), HIV/Immed-ART-12 (n = 70), HIV/Immed-ART-24 (n = 70), and HIV/Def-ART (n = 62) children were scheduled to receive measles vaccination at age 9 and 15–18 months. Antimeasles serum immunoglobulin G titers were quantified using enzyme-linked immunosorbent assay at 4.5 years.ResultsCompared with HIV-unexposed children (2860 mIU/mL), measles antibody geometric mean titers (GMTs) were significantly lower in both HIV/Immed-ART-12 (571; P < .001) and HIV/Immed-ART-24 (1136; P < .001) but similar in the HIV/Def-ART (2777) and HEU (3242) groups. Furthermore, compared with HIV-unexposed, antibody titers ≥330 mIU/mL (ie, presumed serocorrelate for protection; 99%) were also significantly lower in HIV/Immed-ART-12 (70%; P < .001) and HIV/Immed-ART-24 (83%; P < .001) but similar in the HIV/Def-ART (90%) and HEU (98%) groups.ConclusionsHIV-infected children in whom ART was interrupted at either 12 or 24 months had lower GMTs and lower proportions with seroprotective titers than HIV-unexposed children, indicating a potential downside of ART treatment interruption.Clinical Trials RegistrationNCT00099658 and NCT00102960.

Measles, mumps, rubella prevention: how can we do better?

“…Two doses of measlescontaining vaccine administered at 6 and 12 months of age were shown to be similarly safe and immunogenic in HIVunexposed and HIV-exposed, uninfected children [87]. However, HIV-infected children and adolescents may need additional MMR vaccine doses to achieve sufficient levels of immunity, especially if antiretroviral therapy has been interrupted [88]. MMR vaccination may also be considered in patients with other immune deficiencies for whom the benefits of vaccination outweigh the risks, such as patients with immunoglobulin G (IgG) subclass deficiencies, congenital neutropenia, chronic granulomatous disease, and complement deficiency diseases [86].…”

“…Therefore, concerns of possible waning immunity after MMR vaccination has been proposed as a key contributing factor to mumps resurgence, especially in highly vaccinated populations [3,26,152,155,156]. Waning immunity for measles has been well-established in HIV-infected children, in particular if antiretroviral therapy has been interrupted [88]. For rubella, previous studies have shown that following two doses of MMR vaccine during childhood, the seropositivity rates remained high in young adults but antibody concentrations declined below protective levels in some individuals, which could have implications for the prevention of rubella in pregnancy [157][158][159].…”

Seroprotection against measles in previously vaccinated children with difficult-to-treat nephrotic syndrome

“…The seroconversion rate after two doses of the vaccine is around 96%, but there is a slow decline in seroprotection even in healthy children [11]. A greater degree of reduced immunity against measles has been documented in children with malignancies, kidney transplantation, and HIV infection [12][13][14][15]. However, there is little evidence for the same in children with DTNS.…”