Varicella vaccination in HIV-1-infected children after immune reconstitution

• Published in: AIDS (London) Vol. 20; no. 18; pp. 2321 - 2329
• Main Authors: Bekker, Vincent, Westerlaken, Geertje H A, Scherpbier, Henriëtte, Alders, Sophie, Zaaijer, Hans, van Baarle, Debbie, Kuijpers, Taco
• Format: Journal Article
• Language: English
• Published: England 28.11.2006
• Subjects: AIDS/HIV; Antibodies, Viral - analysis; Antibodies, Viral - biosynthesis; Antibody Specificity - immunology; Chickenpox - immunology; Child; Child, Preschool; Cohort Studies; Female; Herpesvirus 3, Human - immunology; HIV Infections - immunology; HIV-1 - immunology; Human immunodeficiency virus 1; Humans; Immunoglobulin G - analysis; Lymphocyte Count; Male; Risk Factors; Siblings; T-Lymphocytes - immunology; Vaccines, Attenuated - therapeutic use; Varicella-zoster virus; Viral Vaccines - adverse effects; Viral Vaccines - therapeutic use
• ISSN: 0269-9370
• DOI: 10.1097/QAD.0b013e3280113f29

HIV-1-infected children have an increased risk of severe chickenpox. However, vaccination is not recommended in severely immunocompromised children. Can the live-attenuated varicella zoster virus (VZV) Oka strain be safely and effectively given to HIV-1-infected children despite previously low CD4 T-cell counts? VZV vaccine was administered twice to 15 VZV-seronegative HIV-1-infected children when total lymphocyte counts were greater than 700 lymphocytes/microl, and six HIV-negative VZV-seronegative siblings. Weekly clinical follow-up and sampling were performed. None of the children developed any clinical symptom or serious adverse reaction after immunization. Only nine (60%) of the HIV-1-infected children had VZV-specific antibodies after two immunizations, whereas 100% of the siblings seroconverted. Age at baseline was negatively correlated with the VZV IgG titre at 6 weeks after the second vaccination in HIV-1-infected children. VZV-specific antibody titres after two immunizations were at a similar level to those found after wild-type infection in non-vaccinated HIV-1-infected patients, but significantly lower than in HIV-negative siblings. Importantly, VZV-specific T-cell responses increased after vaccination and were comparable in both groups over time. Documented wild-type VZV contact in three vaccinated patients did not result in breakthrough infections. VZV vaccination of previously immunocompromised HIV-1-infected children was safe. Vaccination induced specific immune responses in some of the vaccinated HIV-1-infected children, suggesting that previously immunocompromised individuals are protected against severe forms of varicella.