Frota Ana Cristina C, Milagres Lucimar G, Harrison Lee H, Ferreira Bianca, Menna Barreto Daniela, Pereira Gisele S, Cruz Aline C, Pereira-Manfro Wania, de Oliveira Ricardo Hugo, Abreu Thalita F, Hofer Cristina B
From the *Department of Pediatrics and †Department of Preventive Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; ‡Department of Microbiology and Immunology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; and §Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, Pittsburgh, PA.
Pediatr Infect Dis J. 2015 May;34(5):e113-8. doi: 10.1097/INF.0000000000000630.
We aimed to evaluate the Meningococcal (Neisseria meningitidis) C conjugated (MCC) vaccine seroconversion and adverse events (AEs) in HIV-infected and HIV-uninfected children and adolescents in Rio de Janeiro, Brazil.
HIV-infected or HIV-uninfected subjects, 2-18 years old, with CD4+ T-lymphocyte cell (CD4) percentage >15%, without active infection or antibiotic use, were enrolled. All patients were evaluated before and 1-2 months after immunization for seroconversion (defined as ≥4-fold titer increase in human serum bactericidal activity) and at 20 minutes, 3 and 7 days after immunization for AEs. Factors associated with seroconversion among HIV-infected group were studied.
Two hundred four subjects were enrolled: 154 HIV-infected and 50 HIV-uninfected. Median age was 12 years, and 53% were female. Among the HIV-infected group, 82 (53%) had a history of at least 1 C clinical category of Centers for Diseases Control and Prevention event, and 134 (87%) were using combination antiretroviral therapy. The median nadir CD4 percentage was 13% (0-47%). Seventy-six (37.3%) experienced mild AEs. Seroconversion occurred in 46 of 154 (30%) in the HIV-infected group and in 38 of 50 (76%) in the uninfected group (P < 0.01). Factors associated with seroconversion in the HIV-infected group were as follows: never had a C clinical category event [odds ratio (OR) = 2.1, 95% confidence interval (CI): 1.0-4.4]; undetectable viral load at immunization (OR: 2.4, 95% CI: 1.1-5.2) and higher CD4 nadir/100 cells (OR: 1.1, 95% CI: 1.0-1.2).
MCC vaccine should be administered to HIV-infected children and adolescents after maximum immunologic and virologic benefits have been achieved with combination antiretroviral therapy. Our data suggest that a single dose of MCC vaccine is insufficient for HIV-infected individuals 2-18 years of age.
我们旨在评估巴西里约热内卢感染HIV和未感染HIV的儿童及青少年中脑膜炎球菌（脑膜炎奈瑟菌）C结合疫苗（MCC）的血清转化情况及不良事件（AE）。
纳入年龄在2至18岁、CD4 + T淋巴细胞（CD4）百分比> 15%、无活动性感染或未使用抗生素的HIV感染或未感染HIV的受试者。所有患者在免疫前及免疫后1至2个月评估血清转化情况（定义为人类血清杀菌活性滴度增加≥4倍），并在免疫后20分钟、3天和7天评估不良事件。研究了HIV感染组中与血清转化相关的因素。
共纳入204名受试者：154名HIV感染者和50名未感染HIV者。中位年龄为12岁，53%为女性。在HIV感染组中，82例（53%）有至少1次美国疾病控制与预防中心C类临床事件史，134例（87%）正在接受抗逆转录病毒联合治疗。CD4最低点百分比中位数为13%（0 - 47%）。76例（37.3%）出现轻度不良事件。HIV感染组154例中有46例（30%）发生血清转化，未感染组50例中有38例（76%）发生血清转化（P < 0.01）。HIV感染组中与血清转化相关的因素如下：从未发生过C类临床事件[比值比（OR）= 2.1，95%置信区间（CI）：1.0 - 4.4]；免疫时病毒载量不可检测（OR：2.4，95% CI：1.1 - 5.2）以及CD4最低点/100细胞数较高（OR：1.1，95% CI：1.0 - 1.2）。
在通过抗逆转录病毒联合治疗获得最大免疫和病毒学益处后，应给感染HIV的儿童和青少年接种MCC疫苗。我们的数据表明，单剂量MCC疫苗对2至18岁感染HIV的个体不足够。
