Antiretroviral therapy improves measles vaccination response in HIV-infected children

HIV-infected children who fail to develop protective antibodies after initial measles vaccination are more likely to develop these antibodies with subsequent vaccination if they receive highly active antiretroviral therapy (HAART).

In a study reported in the April 1st issue of Clinical Infectious Diseases, Dr. Daniel Johnson, from Mt. Sinai Hospital-Chicago, and colleagues assessed the impact of HAART on the efficacy of measles vaccination in 28 HIV-infected children who lacked protective antibody levels after prior measles vaccination attempts.

Half of the subjects received a HAART regimen and half did not. The HAART regimen was given for at least 4 months prior to the revaccination attempt. The regimen included two nucleoside reverse transcriptase inhibitors (NRTIs) with a protease inhibitor (PI) or a non-NRTI. An alternative HAART regimen included an NRTI with a non-NRTI and a PI, the authors note.

Only three subjects in the non-HAART group demonstrated antimeasles antibodies after vaccination, while nine subjects in the HAART group achieved this response, the researchers note. Both groups had similar CD4+ cell counts at revaccination, but the HAART group had a significantly lower mean HIV load than the non-HAART group.

“Children with HIV who received their MMR vaccination before the use of HAART should be monitored for measles virus antibody and, if test results are negative, revaccinated,” the investigators recommend. “Patients who undergo HAART may require less frequent monitoring and revaccination.”

Dr. Johnson’s team believes that the “response to measles vaccine [seen in children receiving HAART] may reflect a degree of immune system recovery.” The authors add that “further studies are indicated to determine the temporal decline of antibody to measles virus in these patients.”