Seth Anju, Deepa Sudha, Dutta Renu, Chandra Jagdish
From the *Department of Pediatrics, and †Department of Microbiology, Lady Hardinge Medical College, New Delhi, India.
Pediatr Infect Dis J. 2016 Jan;35(1):e8-11. doi: 10.1097/INF.0000000000000934.
Children with HIV (CLHIV) respond poorly to primary immunization with measles vaccine and those responding tend to lose protective titer of antibodies by 2-3 years old. Revaccinating CLHIV after immune reconstitution with antiretroviral therapy (ART) may result in good seroconversion, thereby conferring them protection from measles. The objective was to study prevalence of measles antibodies in CLHIV receiving ART before and after immunization with MMR vaccine.
CLHIV in the age 5-18 years receiving ART for >6 months and with CD 4 count >15% were included in this prospective study. Their serum was assayed for IgG measles antibodies by qualitative immune-enzymatic determination using enzyme linked immunosorbent assay. The subjects were then immunized with a single dose of MMR vaccine. A repeat venous sample was assayed for measles antibodies 8-12 weeks after immunization.
Sixty-six subjects (46 males, 20 females, mean age 10.4 ± 2.8 years) were enrolled. The mean duration of ART was 3.4 ± 1.5 years and median CD4 count 716.5 μ/L (interquartile range: 563.3-950). At enrollment, 16 (24.2%) subjects tested positive, 8 (12.1%) equivocal and 42 (63.6%) negative for measles antibodies. After 8-12 weeks of immunization, 62 (93.3%) tested positive, 1 (1.5%) equivocal, and 3 (4.5%) negative. There was no difference among the seropositive and seronegative subjects postimmunization with respect to age, sex, duration of ART, nutritional status, CD4 count, or WHO clinical stage. No serious adverse reaction was observed to vaccination.
MMR vaccine leads to an excellent seroconversion to measles component of vaccine in immune-reconstituted CLHIV.
感染艾滋病毒的儿童（CLHIV）对麻疹疫苗的初次免疫反应不佳，且有反应者的抗体保护效价往往在2至3岁时就会丧失。在接受抗逆转录病毒疗法（ART）实现免疫重建后对CLHIV进行再接种疫苗，可能会产生良好的血清转化，从而使其获得对麻疹的免疫力。目的是研究接受ART的CLHIV在接种麻疹、腮腺炎和风疹（MMR）疫苗前后麻疹抗体的流行情况。
本前瞻性研究纳入了年龄在5至18岁、接受ART超过6个月且CD4细胞计数>15%的CLHIV。采用酶联免疫吸附测定法通过定性免疫酶法测定其血清中的麻疹IgG抗体。然后让受试者接种一剂MMR疫苗。在接种疫苗8至12周后采集静脉血样再次检测麻疹抗体。
共纳入66名受试者（46名男性，20名女性，平均年龄10.4±2.8岁）。ART的平均疗程为3.4±1.5年，CD4细胞计数中位数为716.5μ/L（四分位间距：563.3 - 950）。入组时，16名（24.2%）受试者麻疹抗体检测呈阳性，8名（12.1%）结果不明确，42名（63.6%）呈阴性。接种疫苗8至12周后，62名（93.3%）检测呈阳性，1名（1.5%）结果不明确，3名（4.5%）呈阴性。免疫接种后，血清阳性和血清阴性受试者在年龄、性别、ART疗程、营养状况、CD4细胞计数或世界卫生组织临床分期方面没有差异。未观察到疫苗接种的严重不良反应。
MMR疫苗可使免疫重建的CLHIV对疫苗中的麻疹成分产生良好的血清转化。
