HIV 暴露和抗逆转录病毒治疗时机对婴儿三价减毒活脊灰疫苗免疫原性的影响。
Effect of HIV-exposure and timing of anti-retroviral treatment on immunogenicity of trivalent live-attenuated polio vaccine in infants.
机构信息
Centre for Vaccines and Immunology, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa.
Department of Health Sciences, University of Johannesburg, Johannesburg, South Africa.
出版信息
PLoS One. 2019 Apr 19;14(4):e0215079. doi: 10.1371/journal.pone.0215079. eCollection 2019.
INTRODUCTION
The prevalence of HIV infection in South African pregnant women has been approximately 30% over the past decade; however, there has been a steady decline in mother-to-child transmission of HIV from 8% in 2008 to <2% in 2015. We evaluated the immunogenicity of live-attenuated trivalent oral polio vaccine (OPV) following the primary vaccination series (doses at birth, 6, 10 and 14 weeks of age) in HIV-exposed uninfected (HEU), HIV-infected infants initiated on early anti-retroviral treatment (HIV+/ART+), HIV-infected infants on deferred ART (HIV+/ART-) and HIV-unexposed infants (HU) as the referent group.
METHODS
Serum polio neutralization antibody titres were evaluated to serotype-1, serotype-2 and serotype-3 at 6, 10 and 18 weeks of age. Antibody titres ≥8 were considered seropositive and sero-protective.
RESULTS
At 18 weeks of age, following the complete primary series of four OPV doses, no differences in GMTs, percentage of infants with sero-protective titres and median fold change in antibody titre (18 weeks vs 6 weeks) were observed in HEU infants (n = 114) and HIV+/ART+ infants (n = 162) compared to HU infants (n = 104) for the three polio serotypes. However, comparing HIV+/ART- infants (n = 70) to HU infants at 18 weeks of age, we observed significantly lower GMTs for serotype-1 (p = 0.022), serotype-2 (p<0.001) and serotype-3 (p<0.001), significantly lower percentages of infants with sero-protective titres for the three serotypes (p<0.001), and significantly lower median fold change in antibody titre for serotype-1 (p = 0.048), serotype-2 (p = 0.003) and serotype-3 (p = 0.008).
CONCLUSION
Delaying initiation of ART in HIV-infected infants was associated with an attenuated immune response to OPV following a four-dose primary series of vaccines, whereas immune responses to OPV in HIV-infected children initiated on ART early in infancy and HEU children were similar to HU infants.
引言
在过去十年中，南非孕妇的 HIV 感染率约为 30%；然而，母婴传播 HIV 的比例从 2008 年的 8%稳步下降到 2015 年的<2%。我们评估了在 HIV 暴露但未感染（HEU）、开始早期抗逆转录病毒治疗（HIV+/ART+）的 HIV 感染婴儿、延迟 ART 的 HIV 感染婴儿（HIV+/ART-）和 HIV 未暴露婴儿（HU）中，经口服减毒三价脊灰疫苗（OPV）初次免疫系列（出生时、6、10 和 14 周龄的剂量）后，活疫苗的免疫原性。
方法
在 6、10 和 18 周龄时，评估血清脊灰中和抗体滴度针对血清型 1、2 和 3。抗体滴度≥8 被认为是血清阳性和血清保护。
结果
在 18 周龄时，在完成四剂 OPV 初次免疫系列后，与 HU 婴儿（n = 104）相比，HEU 婴儿（n = 114）和 HIV+/ART+婴儿（n = 162）的三种脊灰血清型的 GMT、具有血清保护滴度的婴儿百分比和抗体滴度的中位数倍数变化（18 周与 6 周）无差异。然而，与 HU 婴儿相比，在 18 周龄时，与 HU 婴儿相比，HIV+/ART-婴儿（n = 70）观察到血清型 1（p = 0.022）、血清型 2（p<0.001）和血清型 3（p<0.001）的 GMT 显著降低，三种血清型的具有血清保护滴度的婴儿百分比显著降低（p<0.001），血清型 1（p = 0.048）、血清型 2（p = 0.003）和血清型 3（p = 0.008）的抗体滴度中位数倍数变化显著降低。
结论
延迟 HIV 感染婴儿的 ART 开始与四剂初次疫苗系列后 OPV 的免疫反应减弱相关，而在婴儿早期开始 ART 的 HIV 感染儿童和 HEU 儿童对 OPV 的免疫反应与 HU 婴儿相似。
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