Prevalence and Persistence of Varicella Antibodies in Previously Immunized Children and Youth With Perinatal HIV-1 Infection

Abstract

Background: Two doses of live-attenuated varicella-zoster vaccine are recommended for human immunodeficiency virus 1 (HIV-1)-infected children with CD4% ≥ 15%. We determined the prevalence and persistence of antibody in immunized children with perinatal HIV (PHIV) and their association with number of vaccinations, combination antiretroviral therapy (cART), and HIV status.

Methods: The Adolescent Master Protocol is an observational study of children with PHIV and perinatally HIV-exposed but uninfected (PHEU) children conducted at 15 US sites. In a cross-sectional analysis, we tested participants' most recent stored sera for varicella antibody using whole-cell and glycoprotein enzyme-linked immunosorbent assay. Seropositivity predictors were identified using multivariable logistic regression models and C statistics.

Results: Samples were available for 432 children with PHIV and 221 PHEU children; 82% of children with PHIV and 97% of PHEU children were seropositive (P < .001). Seropositivity after 1 vaccine dose among children with PHIV and PHEU children was 100% at <3 years (both), 73% and 100% at 3-<7 years (P < .05), and 77% and 97% at ≥ 7 years (P < .01), respectively. Seropositivity among recipients of 2 vaccine doses was >94% at all intervals. Independent predictors of seropositivity among children with PHIV were receipt of 2 vaccine doses, receipt of 1 dose while on ≥ 3 months of cART, compared with none (adjusted odds ratio [aOR]: 14.0 and 2.8, respectively; P < .001 for overall dose effect), and in those vaccinated ≥ 3 years previously, duration of cART (aOR: 1.29 per year increase, P = .02).

Conclusions: Humoral immune responses to varicella vaccine are best achieved when children with PHIV receive their first dose ≥ 3 months after cART initiation and maintained by completion of the 2-dose series and long-term cART use.

Keywords: HIV; antibodies; perinatal; vaccine; varicella.

© The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

Figures

Figure 1.

Proportion seropositive for varicella by human immunodeficiency virus (HIV) status and the number of varicella vaccine doses received. Vertical bars are exact binomial 95% confidence intervals. Numbers at the bottom of the bars represent seropositive subjects (numerator) and subjects in each category (denominator). Fisher's exact test for subjects with perinatal HIV infection (PHIV) vs perinatally HIV-exposed but uninfected subjects (PHEU): *P < .05, **P < .001.

Figure 2.

Proportion seropositive for varicella among subjects who received 1 and 2 doses of varicella vaccine by human immunodeficiency virus (HIV) status and years from last vaccine dose to specimen date. Vertical bars are exact binomial 95% confidence intervals. Numbers at the bottom of the bars represent varicella seropositive subjects (numerator) and subjects in each category (denominator). Fisher's exact test for subjects with perinatal HIV infection (PHIV) vs perinatally HIV-exposed but uninfected subjects (PHEU): *P < .05, **P < .01.

Figure 3.

Proportion seropositive for varicella among subjects with perinatal human immunodeficiency virus (PHIV) who received 1 and 2 varicella vaccine doses by years from last vaccine dose to specimen date and combination antiretroviral therapy (cART) use. Vertical bars are exact binomial 95% confidence intervals. Numbers at the bottom of the bars represent varicella seropositive subjects (numerator) and subjects in each category (denominator). Fisher's exact test for 1 dose not on ≥3 months cART vs 2 doses: *P < .01.