Department of Virology, Royal Free Hampstead NHS Trust and University College London Medical School, Pond Street, London NW3 2QG, United Kingdom.
J Infect. 2010 Jul;61(1):73-80. doi: 10.1016/j.jinf.2010.04.004. Epub 2010 Apr 18.
Guidelines recommend a proactive approach for offering vaccination to susceptible HIV-infected patients. The size of the HIV-positive population that remains susceptible to vaccine-preventable infections is largely unknown. The study determined serostatus and recalled infection and vaccination history for measles, mumps, rubella, varicella-zoster virus (VZV), hepatitis A, and hepatitis B among HIV-positive adults accessing routine care.
The study recruited 200 consecutive patients with a median CD4 count of 461 (interquartile range 326, 641) cells/mm(3); 62.5% were on suppressive antiretroviral therapy. Patients underwent serological testing and completed a questionnaire about recalled infection and vaccination history.
Seronegativity rates were 7.0% [95% confidence interval 3.9-11.5%] for measles, 12.0% [7.5-16.5%] for mumps, 5.0% [2.4-9.0%] for rubella, 1.5% [0.3-4.3%] for VZV, 19.5% [14.0-25.0%] for hepatitis A, and 22.5% [16.7-28.3%] for hepatitis B. For hepatitis B, seropositivity rates were 6.5% [3.5-10.9%] for surface antigen, 38.0% [31.3-44.7%] for anti-core antibody, and 33.0% [26.5-39.5%] for anti-surface antibody alone. While patients who recalled a history of infection were generally seropositive, up to 50.5% of patients were unsure of their vaccination history.
A proportion of HIV-positive adults lack evidence of immunity against common, vaccine-preventable viral infections. Efforts are needed to improve knowledge and records of vaccination history.
摘要 目的：指南建议对易感 HIV 感染者采取主动接种疫苗的方法。目前尚不清楚仍易感染疫苗可预防感染的 HIV 阳性人群的规模。本研究旨在通过常规护理，确定 HIV 阳性成年人的麻疹、腮腺炎、风疹、水痘带状疱疹病毒（VZV）、甲型肝炎和乙型肝炎血清状态以及既往感染和疫苗接种史。
本研究纳入了 200 例连续就诊的 CD4 中位数为 461（326，641）个细胞/mm³的 HIV 阳性患者；其中 62.5%的患者正在接受抑制性抗逆转录病毒治疗。患者接受血清学检测，并完成了一份关于既往感染和疫苗接种史的问卷。
麻疹、腮腺炎、风疹、VZV、甲型肝炎和乙型肝炎的血清阴性率分别为 7.0%（95%置信区间：3.9-11.5%）、12.0%（7.5-16.5%）、5.0%（2.4-9.0%）、1.5%（0.3-4.3%）、19.5%（14.0-25.0%）和 22.5%（16.7-28.3%）。对于乙型肝炎，表面抗原的血清阳性率为 6.5%（3.5-10.9%）、核心抗体的血清阳性率为 38.0%（31.3-44.7%）、单纯表面抗体的血清阳性率为 33.0%（26.5-39.5%）。尽管那些有既往感染史的患者通常血清学呈阳性，但仍有高达 50.5%的患者对其疫苗接种史不确定。
一部分 HIV 阳性成年人缺乏对常见、疫苗可预防病毒感染的免疫力。需要努力提高对疫苗接种史的了解和记录。
