Response to hepatitis B vaccination in HIV-infected Mexican children
M.L. Cabrera Ruíz1, A. Aranda Medina2, M. Hernández Porras2, L. Xochihua Díaz1, N. Navarrete Delgadillo3, I. Mora Magaña4, L.E. Soto Ramírez5
1Instituto Nacional de Pediatría, Clínica de VIH/SIDA, México-DF, Mexico, 2Instituto Nacional de Pediatría, Servicio de Infectología, México-DF, Mexico, 3Instituto Nacional de Pediatría, Laboratorio de Virología, México-DF, Mexico, 4Instituto Nacional de Pediatría, Unidad de Investigación/Estadísticas, México-DF, Mexico, 5Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Laboratorio de Virología Molecular, México-DF, Mexico
Background: Antibody(Ab) response to Hepatitis B(HB) vaccination in adults, is lower in HIV infected individuals. Since 2000, Mexican vaccination policy includes compulsory HB vaccine at 2,4 and 6 months with a 12yo booster. Our objective was to determine the response to HB vaccination in HIV-infected Mexican children and to correlate it to immunological markers.
Methods: We included all HIV infected children from our AIDS Clinic born after year 2000, that received at least two doses of the HB vaccine and that have anti-HBs Abs measured. Children with Abs >10mUI/ml (DiaSorin, Italy) were considered responders(R). Vaccine response was correlated to CD4+ and CD8+ cell percentages at the moment of vaccination.
Results: Thirty three HIV-perinatally infected children from our clinic were evaluated. We excluded 3 not vaccinated and 2 not tested for Abs. Of the 28 children evaluated, 15 were males and 13 females with mean age of 5.24 y(1-9.1). We had only 5 R in the total population(17.8%).
In 16 cases we had CD4/CD8+ cell values to be analyzed, 7 males and 9 females with mean age of 4.92 y; 4/16(25%) were R, with CD4% ≥25% in one and < 15% in the others. We had 12 non-responders(NR), 4 with ≥25% CD4+ cells, 1 with 15-24%, and 7 with < 15% (p=0.5). CD8% in all R was >45%, while NR had < 25% in 3, 25-45% in 6, and >45% in 3. Vaccine response was significantly related to CD8 >45%. (p=0.019, Fisher test).
Conclusions: Response to HB vaccination in Mexican children with HIV-perinatal infection is lower than in general population (>80% Abs with 2 doses). This response is not related to CD4% at the moment of vaccination, but to CD8%. It should be advisable to apply a booster dose when CD8 cells increase either naturally or with antiretrovirals.
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