Key result
Deferred ART in HIV-infected infants was associated with significantly lower polio sero-protective titres compared to HIV-unexposed infants (p<0.001), whereas early ART yielded similar responses.
Why the study?
Despite high HIV prevalence in South African pregnant women and declining mother-to-child transmission, the immunogenicity of live-attenuated trivalent oral polio vaccine following the primary series across different infant HIV exposure and ART timing groups required evaluation.
Does HIV exposure and the timing of anti-retroviral treatment affect the immunogenicity of the trivalent live-attenuated polio vaccine in infants?
Cohort (n=450)
Does HIV exposure and the timing of anti-retroviral treatment affect the immunogenicity of the trivalent live-attenuated polio vaccine in infants?
p-value: p=<0.001
Delaying ART initiation in HIV-infected infants attenuates the immune response to the oral polio vaccine, highlighting the importance of early ART.
Early ART may preserve polio vaccine responses in HIV+ infants; leaves open need for RCTs to guide practice.
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.
No takes yet. Share an insight, caveat, or question.
Moonsamy et al. (2019) conducted a cohort in HIV infection (n=450). Deferred anti-retroviral treatment vs. HIV-unexposed infants was evaluated on Serum polio neutralization antibody titres and sero-protection at 18 weeks (p=<0.001). Deferred ART in HIV-infected infants was associated with significantly lower polio sero-protective titres compared to HIV-unexposed infants (p<0.001), whereas early ART yielded similar responses.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: