Purswani Murli U, Karalius Brad, Yao Tzy-Jyun, Schmid D Scott, Burchett Sandra K, Siberry George K, Patel Kunjal, Van Dyke Russell B, Yogev Ram, Lurie Robert H, Yogev Ram, Sanders Margaret Ann, Malee Kathleen, Hunter Scott, Shearer William, Paul Mary, Cooper Norma, Harris Lynnette, Purswani Murli, Baig Mahboobullah, Cintron Anna, Puga Ana, Navarro Sandra, Garvie Patricia, Blood James, Burchett Sandra, Karthas Nancy, Kammerer Betsy, Wiznia Andrew, Burey Marlene, Nozyce Molly, Dieudonne Arry, Bettica Linda, Adubato Susan, Chen Janet, Bulkley Maria Garcia, Ivey Latreaca, Grant Mitzie, Knapp Katherine, Allison Kim, Wilkins Megan, Acevedo-Flores Midnela, Rios Heida, Olivera Vivian, Silio Margarita, Jones Medea, Sirois Patricia, Spector Stephen, Norris Kim, Nichols Sharon, McFarland Elizabeth, Katai Alisa, Dunn Jennifer, Paul Suzanne, Scott Gwendolyn, Bryan Patricia, Willen Elizabeth
Division of Pediatric Infectious Disease, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, New York.
Department of Epidemiology.
Clin Infect Dis. 2016 Jan 1;62(1):106-114. doi: 10.1093/cid/civ734. Epub 2015 Sep 18.
Two doses of live-attenuated varicella-zoster vaccine are recommended for human immunodeficiency virus 1 (HIV-1)-infected children with CD4% ≥ 15%. We determined the prevalence and persistence of antibody in immunized children with perinatal HIV (PHIV) and their association with number of vaccinations, combination antiretroviral therapy (cART), and HIV status.
The Adolescent Master Protocol is an observational study of children with PHIV and perinatally HIV-exposed but uninfected (PHEU) children conducted at 15 US sites. In a cross-sectional analysis, we tested participants' most recent stored sera for varicella antibody using whole-cell and glycoprotein enzyme-linked immunosorbent assay. Seropositivity predictors were identified using multivariable logistic regression models and C statistics.
Samples were available for 432 children with PHIV and 221 PHEU children; 82% of children with PHIV and 97% of PHEU children were seropositive (P < .001). Seropositivity after 1 vaccine dose among children with PHIV and PHEU children was 100% at <3 years (both), 73% and 100% at 3-<7 years (P < .05), and 77% and 97% at ≥ 7 years (P < .01), respectively. Seropositivity among recipients of 2 vaccine doses was >94% at all intervals. Independent predictors of seropositivity among children with PHIV were receipt of 2 vaccine doses, receipt of 1 dose while on ≥ 3 months of cART, compared with none (adjusted odds ratio [aOR]: 14.0 and 2.8, respectively; P < .001 for overall dose effect), and in those vaccinated ≥ 3 years previously, duration of cART (aOR: 1.29 per year increase, P = .02).
Humoral immune responses to varicella vaccine are best achieved when children with PHIV receive their first dose ≥ 3 months after cART initiation and maintained by completion of the 2-dose series and long-term cART use.
对于 CD4%≥15% 的人类免疫缺陷病毒 1（HIV-1）感染儿童，推荐接种两剂减毒活水痘带状疱疹疫苗。我们确定了围产期感染 HIV（PHIV）的免疫儿童中抗体的流行率和持久性，以及它们与疫苗接种次数、联合抗逆转录病毒疗法（cART）和 HIV 状态的关联。
青少年主方案是一项在美国 15 个地点对 PHIV 儿童和围产期暴露于 HIV 但未感染（PHEU）儿童进行的观察性研究。在横断面分析中，我们使用全细胞和糖蛋白酶联免疫吸附试验检测参与者最近储存的血清中的水痘抗体。使用多变量逻辑回归模型和 C 统计量确定血清阳性预测因素。
有 432 名 PHIV 儿童和 221 名 PHEU 儿童的样本可供检测；82%的 PHIV 儿童和 97%的 PHEU 儿童血清呈阳性（P <.001）。PHIV 儿童和 PHEU 儿童中，1 剂疫苗接种后血清阳性率在<3 岁时均为 100%，在 3-<7 岁时分别为 73%和 100%（P <.05），在≥7 岁时分别为 77%和 97%（P <.01）。两剂疫苗接种者在所有时间段的血清阳性率均>94%。PHIV 儿童血清阳性的独立预测因素是接种 2 剂疫苗、在接受≥3 个月 cART 时接种 1 剂，与未接种相比（调整后的优势比[aOR]分别为 14.0 和 2.8；总体剂量效应 P <.001），以及在≥3 年前接种疫苗的儿童中，cART 的持续时间（aOR：每年增加 1.29，P =.02）。
当 PHIV 儿童在开始 cART 后≥3 个月接种第一剂水痘疫苗，并通过完成 2 剂系列接种和长期使用 cART 来维持时，对水痘疫苗的体液免疫反应最佳。
