Background Despite recent advancements in HIV management, HIV-1-infected children in sub-Saharan Africa are still vulnerable to vaccine-preventable infections. When vaccinated, these children do not develop normal immune responses and thus may not develop protective immunity. It has previously been shown in HIV-1-infected adults that antibody titers are lower than controls at baseline and that revaccination response is correlated with CD4 count. Therefore, placing children on highly active antiretroviral therapy (HAART) may positively affect their response to revaccination, due to a decrease in viral load and increase in CD4 count.
Methods To address the question of how HAART affects vaccine response, it is necessary to first adequately describe baseline antibody levels in this cohort. To do this, children between 2 years and 12 years of age, all of whom are WHO Stage II/III or with CD4 < 15%, are enrolled into a prospective cohort study. Baseline CD4 count, viral load, tetanus and measles antibody titers are assessed and children with negative vaccine titers at 6 months post initiation of HAART are revaccinated at 8 months. Using an indirect ELISA method against tetanus antigen, tetanus antibody titers at baseline have been calculated for a subset of the study population.
Results Of the nine children screened, one (11%) had protective levels of antibodies, while the other eight had borderline levels of protective antibody. These eight children, therefore, will need to have antibody titers checked again at 6 months post initiation of HAART, with the possibility of revaccination at 8 months. Tetanus antibody titers were positively correlated with baseline absolute CD4 count (Pearson, Rho = 0.77, p = .025), but not baseline CD percentage (Rho = 0.28, p = .51).
Conclusions Tetanus titers at baseline are positively correlated with absolute CD4 count at baseline. In the future, we will (1) compare baseline titers with 6-month post HAART initiation titers, (2) correlate baseline and 6-month titers to CD4 counts and viral loads, and (3) correlate revaccination response to CD4 count and viral loads.
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