甲型肝炎疫苗接种后 HIV 感染成年人免疫应答的长期持久性。
Long-term durability of immune responses after hepatitis A vaccination among HIV-infected adults.
机构信息
Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
出版信息
J Infect Dis. 2011 Jun 15;203(12):1815-23. doi: 10.1093/infdis/jir180.
BACKGROUND
Vaccination provides long-term immunity to hepatitis A virus (HAV) among the general population, but there are no such data regarding vaccine durability among human immunodeficiency virus (HIV)-infected adults.
METHODS
We retrospectively studied HIV-infected adults who had received 2 doses of HAV vaccine. We analyzed blood specimens taken at 1 year, 3 years, and, when available, 6-10 years postvaccination. HAV immunoglobulin G (IgG) values of ≥10 mIU/mL were considered seropositive.
RESULTS
We evaluated specimens from 130 HIV-infected adults with a median age of 35 years and a median CD4 cell count of 461 cells/mm(3) at or before time of vaccination. Of these, 49% had an HIV RNA load <1000 copies/mL. Initial vaccine responses were achieved in 89% of HIV-infected adults (95% confidence interval [CI], 83%-94%), compared with 100% (95% CI, 99%-100%) of historical HIV-uninfected adults. Among initial HIV-infected responders with available specimens, 90% (104 of 116; 95% CI, 83%-95%) remained seropositive at 3 years and 85% (63 of 74; 95% CI, 75%-92%) at 6-10 years. Geometric mean concentrations (GMCs) among HIV-infected adults were 154, 111, and 64 mIU/mL at 1, 3, and 6-10 years, respectively, compared with 1734, 687, and 684 mIU/mL among HIV-uninfected persons. Higher GMCs over time among HIV-infected adults were associated with lower log(10) HIV RNA levels (β = -.12, P = .04).
CONCLUSIONS
Most adults with well-controlled HIV infections had durable seropositive responses up to 6-10 years after HAV vaccination. Suppressed HIV RNA levels are associated with durable HAV responses.
背景
甲型肝炎病毒 (HAV) 疫苗为普通人群提供了长期的免疫保护，但在感染人类免疫缺陷病毒 (HIV) 的成年人中，尚无关于疫苗持久性的数据。
方法
我们回顾性研究了接受 2 剂 HAV 疫苗接种的 HIV 感染成年人。我们分析了接种后 1 年、3 年以及有条件时 6-10 年采集的血标本。HAV 免疫球蛋白 G (IgG) 值≥10 mIU/mL 被认为是血清阳性。
结果
我们评估了 130 名 HIV 感染成年人的标本，这些成年人的中位年龄为 35 岁，中位 CD4 细胞计数为接种前或接种时的 461 个细胞/mm3。其中，49%的 HIV RNA 载量<1000 拷贝/mL。与 100%（95%置信区间[CI]，99%-100%）的历史 HIV 未感染者相比，89%（95%CI，83%-94%）的 HIV 感染者最初对疫苗有反应。在最初对 HIV 有反应且有可用标本的感染者中，90%（104 例中有 116 例；95%CI，83%-95%）在 3 年内仍为血清阳性，85%（63 例中有 74 例；95%CI，75%-92%）在 6-10 年内仍为血清阳性。HIV 感染者的几何平均浓度（GMC）分别为接种后 1 年时 154 mIU/mL、3 年时 111 mIU/mL 和 6-10 年时 64 mIU/mL，而 HIV 未感染者分别为 1734 mIU/mL、687 mIU/mL 和 684 mIU/mL。HIV 感染者随着时间的推移，GMC 升高与 HIV RNA 水平降低相关（β=-0.12，P=0.04）。
结论
大多数 HIV 感染控制良好的成年人在接种 HAV 疫苗后 6-10 年内仍保持持久的血清阳性反应。抑制 HIV RNA 水平与持久的 HAV 反应相关。
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