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Clin Infect Dis. 2018 Mar 19;66(7):1099-1108. doi: 10.1093/cid/cix960.

Long-term Immune Response to Yellow Fever Vaccination in Human Immunodeficiency Virus (HIV)-Infected Individuals Depends on HIV RNA Suppression Status: Implications for Vaccination Schedule.

Author information

1
Department of Infectious Diseases, Bern University Hospital, University of Bern.
2
Department of Medicine, Swiss Tropical and Public Health Institute.
3
University of Basel, Switzerland.
4
Institute of Epidemiology, Biostatistics and Prevention, University of Zürich, Switzerland.
5
Robert Koch Institute, Berlin, Germany.
6
Division of Infectious Diseases, University Hospital of Lausanne.
7
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University Basel.
8
Division of Infectious Diseases, University Hospital of Geneva.
9
Division of Infectious Diseases, Regional Hospital of Lugano.
10
Division of Infectious Diseases, Cantonal Hospital of St Gallen.
11
Institute of Social and Preventive Medicine, University of Bern, Switzerland.

Abstract

Background:

In human immunodeficiency virus (HIV)-infected individuals, the immune response over time to yellow fever vaccination (YFV) and the necessity for booster vaccination are not well understood.

Methods:

We studied 247 participants of the Swiss HIV Cohort Study (SHCS) with a first YFV after HIV diagnosis and determined their immune responses at 1 year, 5 years, and 10 years postvaccination by yellow fever plaque reduction neutralization titers (PRNTs) in stored blood samples. A PRNT of 1:≥10 was regarded as reactive and protective. Predictors of vaccination response were analyzed with Poisson regression.

Results:

At vaccination, 82% of the vaccinees were taking combination antiretroviral therapy (cART), 83% had suppressed HIV RNA levels (<400 copies/mL), and their median CD4 T-cell count was 536 cells/μL. PRNT was reactive in 46% (95% confidence interval [CI], 38%-53%) before, 95% (95% CI, 91%-98%) within 1 year, 86% (95% CI, 79%-92%) at 5 years, and 75% (95% CI, 62%-85%) at 10 years postvaccination. In those with suppressed plasma HIV RNA at YFV, the proportion with reactive PRNTs remained high: 99% (95% CI, 95%-99.8%) within 1 year, 99% (95% CI, 92%-100%) at 5 years, and 100% (95% CI, 86%-100%) at 10 years.

Conclusions:

HIV-infected patients' long-term immune response up to 10 years to YFV is primarily dependent on the control of HIV replication at the time of vaccination. For those on successful cART, immune response up to 10 years is comparable to that of non-HIV-infected adults. We recommend a single YFV booster after 10 years for patients vaccinated on successful cART, whereas those vaccinated with uncontrolled HIV RNA may need an early booster.

PMID:
29140432
DOI:
10.1093/cid/cix960

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