Department of Pediatrics, Chulalongkorn University, Bangkok, Thailand.
Pediatr Infect Dis J. 2011 Apr;30(4):320-4. doi: 10.1097/INF.0b013e3181fe0868.
The live attenuated varicella vaccine is recommended for HIV-infected children who are not severely immunosuppressed. This study aimed to assess the immunogenicity and safety of varicella vaccination among HIV-infected children who had severe immunosuppression before receiving antiretroviral therapy.
Sixty HIV-infected children with no history of chickenpox or herpes zoster infection with CD4 T lymphocyte counts ≥ 15% or ≥ 200 cell/mm were enrolled. Two doses of varicella vaccine were administered at the time of enrollment and at 3 months. Varicella zoster virus (VZV) antibody was tested at baseline and 3 months after each dose by the enzyme-linked immunosorbent assay technique. An antibody titer >20 HU/mL was regarded as protective.
The median (interquartile range) of age, CD4 nadir, and current CD4 percentage were 11.2 (8.5-12.8) years, 9.5% (3-14), and 28% (22-32), respectively. Fifty-seven children (95%) received antiretroviral therapy for a median of 27 months. Among 34 children (57%) who were VZV seronegative at baseline, 11.8% (95% CI, 3.3%-27.5%) and 79.4% (95% CI, 62.1%-91.3%) were VZV seroconverted after first and second dose of vaccine, respectively. Children who had VZV seroconversion were more likely to have HIV RNA <1.7 copies/mL (92.6% vs. 71.4%, P = 0.18). Among 26 children who were seropositive at baseline, the geometric mean titers were increased from 56.7 to 107.9 and 134.6 unit/mL, respectively. Local and systemic reactions of grade 1 and 2 were reported in 13% and 4% of children, respectively. There was a trend toward better response among children with younger age, high CD4, and viral suppression.
Administration of the 2 doses of varicella vaccine resulted in high seroconversion rates without serious adverse reactions. Varicella vaccination for HIV-infected children should be encouraged.
活减毒水痘疫苗推荐用于未严重免疫抑制的 HIV 感染儿童。本研究旨在评估在接受抗逆转录病毒治疗前有严重免疫抑制的 HIV 感染儿童中接种水痘疫苗的免疫原性和安全性。
纳入 60 名无水痘或带状疱疹感染史且 CD4 淋巴细胞计数≥15%或≥200 个细胞/mm 的 HIV 感染儿童。在入组时和 3 个月时给予两剂水痘疫苗。在基线和每次剂量后 3 个月通过酶联免疫吸附试验技术检测水痘带状疱疹病毒（VZV）抗体。抗体滴度>20 HU/mL 被认为是保护性的。
中位（四分位距）年龄、CD4 最低点和当前 CD4%分别为 11.2（8.5-12.8）岁、9.5%（3-14）和 28%（22-32）。57 名儿童（95%）接受抗逆转录病毒治疗，中位时间为 27 个月。在 34 名基线时 VZV 血清阴性的儿童中，分别有 11.8%（95%CI，3.3%-27.5%）和 79.4%（95%CI，62.1%-91.3%）在接种第一剂和第二剂疫苗后发生 VZV 血清转化。发生 VZV 血清转化的儿童更有可能 HIV RNA<1.7 拷贝/mL（92.6% vs. 71.4%，P=0.18）。在 26 名基线时血清阳性的儿童中，几何平均滴度分别从 56.7 增加到 107.9 和 134.6 单位/mL。分别有 13%和 4%的儿童报告了 1 级和 2 级的局部和全身反应。年龄较小、CD4 较高和病毒抑制的儿童有更好的反应趋势。
给予两剂水痘疫苗可产生较高的血清转化率，且无严重不良反应。应鼓励对 HIV 感染儿童进行水痘疫苗接种。
