Madhi Shabir A, Klugman Keith P, Kuwanda Locadiah, Cutland Clare, Käyhty Helena, Adrian Peter
Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand/Medical Research Council, Johannesburg, South Africa.
J Infect Dis. 2009 Apr 15;199(8):1168-76. doi: 10.1086/597388.
Administration of pneumococcal conjugate vaccine (PCV) to HIV-infected children during infancy confers limited long-term protection in the absence of antiretroviral therapy. The objective of the present study was to determine the immune responses to PCV at 5 years of age in HIV-infected and HIV-uninfected children who had been primed with vaccine during infancy (i.e., previous vaccinees) and in those receiving their first dose of vaccine (i.e., control subjects).
Serotype-specific antibodies were quantified by enzyme immunoassay, and antibody functionality to serotypes 6B, 9V, and 19F were evaluated using an opsonophagocytic killing assay 1 month after vaccination.
Of the HIV-infected children, 19.7% were receiving antiretroviral therapy, and 40.5% had a CD4(+) cell percentage <15%. Geometric mean concentrations of antibody and the proportion with a concentration 0.35 microg/mL after vaccination were greater among HIV-uninfected children than among HIV-infected children for both previous vaccinees and control subjects. Antibody concentrations after vaccination were lower for 3 of 7 serotypes among HIV-infected previous vaccinees than among control subjects. Detectable opsonophagocytic activity to all studied serotypes was lower among HIV-infected than among HIV-uninfected previous vaccinees and control subjects. Postvaccination antibody-mediated killing activity as determined by the opsonophagocytic killing assay was enhanced in control subjects compared with previous vaccinees among HIV-uninfected children.
HIV-infected vaccinees experience a partial loss of anamnestic responses to PCV. The optimal timing and frequency of booster vaccination as well as the responses to them among HIV-infected children need to be determined.
在婴儿期给感染HIV的儿童接种肺炎球菌结合疫苗（PCV），在没有抗逆转录病毒治疗的情况下，提供的长期保护有限。本研究的目的是确定在婴儿期接种过疫苗的HIV感染儿童和未感染HIV的儿童（即之前接种过疫苗的儿童）以及首次接种疫苗的儿童（即对照受试者）在5岁时对PCV的免疫反应。
通过酶免疫测定法定量血清型特异性抗体，并在接种疫苗1个月后使用吞噬杀菌试验评估对6B、9V和19F血清型的抗体功能。
在感染HIV的儿童中，19.7%正在接受抗逆转录病毒治疗，40.5%的CD4(+)细胞百分比<15%。对于之前接种过疫苗的儿童和对照受试者，未感染HIV的儿童接种疫苗后的抗体几何平均浓度以及浓度≥0.35μg/mL的比例均高于感染HIV的儿童。在感染HIV的之前接种过疫苗的儿童中，7种血清型中有3种接种疫苗后的抗体浓度低于对照受试者。与未感染HIV的之前接种过疫苗的儿童和对照受试者相比，感染HIV的儿童对所有研究血清型的可检测吞噬杀菌活性较低。在未感染HIV的儿童中，与之前接种过疫苗的儿童相比，通过吞噬杀菌试验测定的接种疫苗后抗体介导的杀伤活性在对照受试者中增强。
感染HIV的疫苗接种者对PCV的回忆反应部分丧失。需要确定在感染HIV的儿童中加强免疫的最佳时间和频率以及他们对加强免疫的反应。
