Effect of HIV exposure and timing of antiretroviral therapy initiation on immune memory responses to diphtheria, tetanus, whole cell pertussis and hepatitis B vaccines
Simani, O.E Izu, A Nunes, M.C Violari, A Cotton, M.F Van Niekerk, N Adrian, P.V Madhi, S.A
Simani, O.E
Izu, A
Nunes, M.C
Violari, A
Cotton, M.F
Van Niekerk, N
Adrian, P.V
Madhi, S.A
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Abstract
Objectives: We evaluated memory responses and antibody persistence to diphtheria-toxoid, tetanus-toxoid, whole-cell-pertussis (DTwP), and Hepatitis-B vaccines in HIV-unexposed, HIV-exposed-uninfected and HIV-infected children previously randomized to initiate time-limited ART at 6-10 weeks (ART-Immed) or when clinically/immunologically indicated (ART-Def).
Methods: All children received DTwP booster at 15-18 months. Antibodies were measured for pertussis-toxoid, filamentous haemagglutinin (FHA), diphtheria-toxoid, tetanus-toxoid, and hepatitis-B prior to booster, 1-2 weeks post-booster and at 24 months of age.
Results: Pre-booster antibody GMC were lower in HIV-infected groups than HIV-unexposed children for all epitopes. Post-booster and at 24 months of age, the ART-Def group had lower GMCs and antibody proportion ≥0.1 IU/ml for tetanus-toxoid and diphtheria-toxoid compared to HIV-unexposed children. At 24 months of age, the ART-Immed group had higher GMCs, and more likely to maintain antibody titres ≥1.0 IU/ml to tetanus-toxoid and diphtheria-toxoid compared to HIV-unexposed children. Compared to HIV-unexposed children, at 15 and 24 months of age, persistence of antibody to HBsAg of ≥10 mIU/ml was similar in the ART-Immed group but lower among the ART-Def group. Antibody kinetics indicated more robust memory responses in HIV-exposed-uninfected than HIV-unexposed children to diphtheria-toxoid and wP.
Conclusion: HIV-infected children not on ART at primary vaccination had poorer memory responses, whereas HIV-exposed-uninfected children mounted robust memory responses.
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Date
2018-11-19
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Taylor & Francis
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Keywords
Diphtheria-toxoid,HIV-exposed uninfected,HIV-infected,booster,hepatitis B vaccine,pertussis vaccine,tetanus-toxoid
Citation
Simani OE, Izu A, Nunes MC, Violari A, Cotton MF, Van Niekerk N, Adrian PV, Madhi SA. Effect of HIV exposure and timing of antiretroviral therapy initiation on immune memory responses to diphtheria, tetanus, whole cell pertussis and hepatitis B vaccines. Expert Rev Vaccines. 2019 Jan;18(1):95-104. doi: 10.1080/14760584.2019.1547195.