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Durability of antibody responses after receipt of the monovalent 2009 pandemic influenza A (H1N1) vaccine among HIV-infected and HIV-uninfected adults |
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| Authors: | Crum-Cianflone Nancy F Iverson Erik Defang Gabriel Blair Patrick J Eberly Lynn E Maguire Jason Ganesan Anuradha Faix Dennis Duplessis Christopher Lalani Tahaniyat Whitman Timothy Brandt Carolyn Macalino Grace Millar Eugene V Burgess Timothy |
| Affiliation: | a Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA b Infectious Disease Clinic, Naval Medical Center San Diego, San Diego, CA, USA c Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA d Naval Medical Research Center, Silver Spring, MD, USA e Naval Health Research Center, San Diego, CA, USA f Infectious Disease Clinic, National Naval Medical Center, Bethesda, MD, USA |
| Abstract: | BackgroundHuman immunodeficiency virus (HIV)-infected persons are at risk for severe influenza infections. Although vaccination against the H1N1 pandemic influenza strain is recommended, currently there are no data on the durability of post-vaccination antibody responses in this population.MethodsHIV-infected and HIV-uninfected adults (18-50 years old) received a single dose of monovalent 2009 influenza A (H1N1) vaccine (strain A/California/7/2009H1N1). Antibody levels to the 2009 H1N1 pandemic strain were determined at day 0, day 28, and 6 months by hemagglutination-inhibition assay. A seroprotective response was a post-vaccination titer of ≥1:40 among those with a pre-vaccination level of ≤1:10. Geometric mean titers (GMT) and factors associated with higher levels were also evaluated.ResultsWe studied 127 participants with a median age of 35 (interquartile range (IQR) 28, 42) years. Among the HIV-infected arm (n = 63), the median CD4 count was 595 (IQR 476, 819) cells/mm3 and 83% were receiving HAART. Thirty-five percent of all participants had a pre-vaccination level of >1:10. HIV-infected compared to HIV-uninfected adults were less likely to generate a seroprotective response at day 28 (54% vs. 75%, adjusted OR 0.23, p = 0.021) or have a durable response at 6 months post-vaccination (28% vs. 56%, adjusted OR 0.19, p = 0.005). Additionally, although pre-vaccination GMT were similar in both arms (median 7 vs. 8, p = 0.11), the GMT at 6 months was significantly lower among HIV-infected versus HIV-uninfected adults (median 20 vs. 113, p = 0.003). Among HIV-infected persons, younger age (p = 0.035) and receipt of HAART (p = 0.028) were associated with higher GMTs at 6 months.ConclusionsDespite vaccination, most HIV-infected adults do not generate durable seroprotective antibody responses to the 2009 influenza A (H1N1) virus, and hence may remain vulnerable to infection. In addition to HAART use, more immunogenic vaccines are likely needed for improving protection against influenza in this population. |
| Keywords: | Influenza Pandemic 2009 H1N1 Vaccine responses HIV Durability Long-term immunity |
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