1st Cardiology Department, Athens Medical School, Hippokration Hospital, Athens, Greece.
HIV Med. 2011 Nov;12(10):594-601. doi: 10.1111/j.1468-1293.2011.00935.x. Epub 2011 Jun 5.
Vaccination of HIV-infected patients against the influenza A/H1N1 subtype was proposed as a mandatory precautionary measure during the 2009 pandemic. The immediate cardiovascular effects of the novel vaccine have been largely unexplored. We investigated the impact of vaccination on indices of endothelial function in a cohort of HIV-infected patients.
We included 24 HIV-infected patients in a study with a randomized, sham procedure-controlled design. A monovalent, adjuvanted vaccine against influenza A/H1N1 was used in the vaccine arm (n=16); patients in the control group (n=8) were subjected to a sham procedure. Endothelial function, as assessed by flow-mediated dilatation (FMD), and inflammatory markers were assessed prior to and 8 and 48 h post vaccination.
FMD deteriorated following vaccination (baseline, 6.5 ± 1.1%; 8 h, 1.1 ± 1.5%; 48 h, 2.0 ± 1.4%; P=0.04). The white blood cell count increased at 8 h and remained elevated at 48 h. Soluble intercellular adhesion molecule-1 levels decreased after vaccination; the maximum decrease was noted at 48 h. Conversely, the sham procedure did not induce changes in endothelial function or inflammatory markers, apart from a reduction in the white blood cell count at 48 h.
Acute systemic inflammation induced by vaccination against the influenza A/H1N1 virus resulted in a deterioration in endothelial function in HIV-infected patients, and this effect was sustained for at least 48 h. Our findings may have important implications in view of the high cardiovascular risk that HIV infection carries. The effect of the novel vaccine on endothelial function should be weighed against the immunological protection that it confers.
在 2009 年流感大流行期间，有人提议为 HIV 感染者接种甲型 H1N1 流感疫苗，作为强制性预防措施。新型疫苗对心血管系统的即时影响在很大程度上尚未得到探索。我们研究了接种疫苗对 HIV 感染者内皮功能指数的影响。
我们采用随机、假手术对照设计，纳入了 24 例 HIV 感染者进行研究。在疫苗组（n=16）中使用了一种针对甲型 H1N1 的单价、佐剂流感疫苗；对照组（n=8）患者接受假手术。在接种疫苗前以及接种后 8 小时和 48 小时，评估内皮功能（通过血流介导的扩张率 [FMD] 评估）和炎症标志物。
接种疫苗后 FMD 恶化（基线时为 6.5±1.1%；8 小时时为 1.1±1.5%；48 小时时为 2.0±1.4%；P=0.04）。白细胞计数在 8 小时时增加，并在 48 小时时持续升高。接种疫苗后可溶性细胞间黏附分子-1 水平下降，最大降幅发生在 48 小时。相反，除了在 48 小时时白细胞计数减少外，假手术并未引起内皮功能或炎症标志物的变化。
甲型 H1N1 流感病毒疫苗接种引起的急性全身炎症导致 HIV 感染者的内皮功能恶化，这种影响至少持续 48 小时。鉴于 HIV 感染带来的高心血管风险，我们的发现可能具有重要意义。新型疫苗对内皮功能的影响应与它所提供的免疫保护作用权衡。
