NIH [to 22 August 2015]
http://www.nih.gov/news/releases.htm
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:: Large percentage of youth with HIV may lack immunity to measles, mumps, rubella
NIH study finds those vaccinated before starting modern HIV therapy may be at risk.
August 13, 2015 —Between one-third and one-half of individuals in the United States who were infected with HIV around the time of birth may not have sufficient immunity to ward off measles, mumps, and rubella—even though they may have been vaccinated against these diseases. This estimate, from a National Institutes of Health research network, in collaboration with the Centers for Disease Control and Prevention, is based on a study of more than 600 children and youth exposed to HIV in the womb.
“Having a high level of immunity to measles, mumps, and rubella is important not only for an individual’s health, but also for preventing disease outbreaks in the larger community,” said the study’s first author, George K. Siberry, M.D., Medical Officer in the Maternal and Pediatric Infectious Disease Branch of NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). “Individuals infected with HIV at birth who did not have the benefit of combined antiretroviral therapy before they were vaccinated should speak with their physician about whether they need a repeated course of the vaccine.” The study was published online in Clinical Infectious Diseases…
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Clinical Infectious Diseases (CID)
Volume 61 Issue 5 September 1, 2015
http://cid.oxfordjournals.org/content/current
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Advance Access
Immunity to Measles, Mumps, and Rubella in US Children With Perinatal HIV Infection or Perinatal HIV Exposure Without Infection
George K. Siberry1, Kunjal Patel2, William J. Bellini3, Brad Karalius2, Murli U. Purswani4,
Sandra K. Burchett5, William A. Meyer III6, Sun Bae Sowers3, Angela Ellis7, and Russell B. Van Dyke8 for the Pediatric HIV AIDS Cohort Study (PHACS)
Author Affiliations
1Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
2Department of Epidemiology, Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
3Measles, Mumps, Rubella, and Herpesviruses Laboratory Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
4Albert Einstein College of Medicine, Bronx-Lebanon Hospital Center, New York
5Boston Children’s Hospital and Harvard Medical School, Massachusetts
6Quest Diagnostics, Baltimore, Maryland
7Frontier Science and Technology Research Foundation, Inc, Buffalo, New York
8Tulane University School of Medicine, New Orleans, Louisiana
Correspondence: George K. Siberry, MD, MPH, Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6100 Executive Blvd, Rm 4B11H, Bethesda, MD 20892-7510 (siberryg@mail.nih.gov).
Presented in part: Fourth International Workshop on HIV Pediatrics, Washington, District of Columbia, 20–21 July 2012, Oral presentation.
Abstract
Background.  Children with perinatal human immunodeficiency virus (HIV) infection (PHIV) may not be protected against measles, mumps, and rubella (MMR) because of impaired initial vaccine response or waning immunity. Our objectives were to estimate seroimmunity in PHIV-infected and perinatally HIV-exposed but uninfected (HEU) children and identify predictors of immunity in the PHIV cohort.
Methods. PHIV and HEU children were enrolled in the Pediatric HIV/AIDS Cohort Study (PHACS) at ages 7–15 years from 2007 to 2009. At annual visits, demographic, laboratory, immunization, and clinical data were abstracted and serologic specimens collected. Most recent serologic specimen was used to determine measles seroprotection by plaque reduction neutralization assay and rubella seroprotection and mumps seropositivity by enzyme immunoassay. Sustained combination antiretroviral therapy (cART) was defined as taking cART for at least 3 months.
Results. Among 428 PHIV and 221 HEU PHACS participants, the prevalence was significantly lower in PHIV children for measles seroprotection (57% [95% confidence interval {CI}, 52%–62%] vs 99% [95% CI, 96%–100%]), rubella seroprotection (65% [95% CI, 60%–70%] vs 98% [95% CI, 95%–100%]), and mumps seropositivity (59% [95% CI, 55%–64%] vs 97% [95% CI, 94%–99%]). On multivariable analysis, greater number of vaccine doses while receiving sustained cART and higher nadir CD4 percentage between last vaccine dose and serologic testing independently improved the cumulative prediction of measles seroprotection in PHIV. Predictors of rubella seroprotection and mumps seropositivity were similar.
Conclusions.  High proportions of PHIV-infected children, but not HEU children, lack serologic evidence of immunity to MMR, despite documented immunization and current cART. Effective cART before immunization is a strong predictor of current seroimmunity.