Children with HIV in whom antiretroviral therapy (ART) was interrupted at either 12 or 24 months had lower geometric mean titers (GMTs) and lower proportions with seroprotective measles antibody titers than HIV-unexposed children, indicating a potential downside of ART treatment interruption. This according to a recent cohort study that followed participants from 6-12 weeks though 4.5 years of age. HIV-unexposed (n=95), HIV-exposed-uninfected (HEU; n=84), HIV/Immed-ART-12 (n=70), HIV/Immed-ART-24 (n=70), and HIV/Def-ART (n=62) children were scheduled to receive measles vaccination at 9 and 15-18 months of age. Anti-measles serum IgG titers were quantified at 4.5 years. Researchers found:
- Compared with HIV-unexposed children, GMTs were significantly lower in both HIV/Immed-ART-12 and HIV/Immed-ART-24, but similar in the HIV/Def-ART and HEU.
- Also, antibody titers ≥330 mIU/mL were significantly lower in HIV/Immed-ART-12 and HIV/Immed-24 when compared with HIV-unexposed, but were similar in the HIV/Def-ART and HEU groups.
- These results indicate a potential downside of ART treatment interruption.
Mutsaerts EAML, Nunes MC, van Rijswijk MN, et al. Measles immunity at 4.5 years of age following vaccination at 9 and 15-18 months of age among HIV-infected, HIV-exposed-uninfected and HIV-unexposed children. [Published online ahead of print November 12, 2018]. Clin Infect Dis. doi:10.1093/cid/ciy964.
There have been studies that hypothesized that if children receive early onset ART, close to primary infection, that children could be permitted some time off ART. This study would show that in children in whom ART is interrupted, the response to measles vaccination may be decreased. This might need to be accounted for in immunization schedules for HIV positive children and adolescents that are on an interrupted ART schedule or not on ART at the time of measles immunization. It did show that if vaccination is given during ART, then responses are comparable to healthy children. —John Russell, MD
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