Human Immunodeficiency Virus Exposure but Not Early Cytomegalovirus Infection Is Associated With Increased Hospitalization and Decreased Memory T-Cell Responses to Tetanus Vaccine. (10th November 2019)

• Record Type: Journal Article
• Authors: Smith, Christiana; Moraka, Natasha O; Ibrahim, Maryanne; Moyo, Sikhulile; Mayondi, Gloria; Kammerer, Betsy; Leidner, Jean; Gaseitsiwe, Simani; Li, Shaobing; Shapiro, Roger; Lockman, Shahin; Weinberg, Adriana
• Is Part Of: Journal of infectious diseases. Volume 221:Number 7(2020)
• Page Start: 1167
• Page End: 1175
• Publication Date: 2019-11-10
• Subjects: BCG vaccine -- cytomegalovirus -- HIV-exposed infant -- hospitalization -- tetanus vaccine; Communicable diseases -- Periodicals; Diseases -- Causes and theories of causation -- Periodicals; Medicine -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.9
• DOI: 10.1093/infdis/jiz590
• Languages: English
• ISSNs: 0022-1899

Abstract

Abstract: Background: Human immunodeficiency virus (HIV)-exposed, uninfected (HEU) infants experience high rates of infectious morbidity. We hypothesized that early cytomegalovirus (CMV) infection was associated with increased hospitalization rates and decreased vaccine responses in HEU compared with HIV-unexposed (HUU) infants. Methods: Among infants enrolled in the Tshipidi study in Botswana, we determined CMV infection status by 6 months of age and compared hospitalization rates and responses to tetanus and Bacille Calmette-Guérin vaccines among HEU and HUU vaccinees. Results: Fifteen of 226 (6.6%) HEU infants and 17 (19.3%) of 88 HUU infants were CMV-infected by 6 months. The HEU infants were approximately 3 times as likely to be hospitalized compared with HUU infants ( P = .02). The HEU peripheral blood cells produced less interleukin (IL)-2 ( P = .004), but similar amounts of interferon-γ, after stimulation with tetanus toxoid. Antitetanus immunoglobulin G titers were similar between groups. Cellular responses to purified protein derivative stimulation did not differ between groups. Maternal receipt of 3-drug antiretroviral therapy compared with zidovudine was associated with increased IL-2 expression after tetanus toxoid stimulation. The infants' CMV infection status was not associated with clinical or vaccine response outcomes. Conclusions: We observed that increased rates of hospitalization and decreased memory T-cell responses to tetanus vaccine were associated with HIV exposure and incomplete treatment of maternal HIV infection, but not early CMV infection. Abstract : We found increased rates of infection-related hospitalization and decreased cellular responses to the tetanus vaccine among HIV-exposed, uninfected compared with HIV-unexposed infants. Incomplete treatment of maternal HIV, but not early infant CMV infection, was associated with decreased vaccine responses.