Pneumococcal and influenza immunization and human immunodeficiency virus load in children.
OBJECTIVE
HIV-infected children receiving influenza vaccine, pneumococcal vaccine and both vaccines concurrently were studied to examine the effect of immunization on plasma HIV viral load.


METHODS
Thirteen children received immunizations: pneumococcal vaccine, 5; pneumococcal and influenza vaccines, 7; and influenza vaccine, 1. Most patients (12 of 13) were receiving combination reverse transcriptase inhibitor antiretroviral therapy without protease inhibitors at the time of immunization. Baseline plasma HIV RNA was determined 1 month prior (11 of 13), 2 weeks prior (12 of 13) and on the day of immunization (12 of 13). Plasma HIV RNA was assayed at 2 weeks (11 of 13), 4 weeks (12 of 13) and 3 months (5 of 13) after immunization. T cell activation markers (HLA-DR+, CD38+ and CD45RO+, CD28+) were examined for both CD4+ and CD8+ lymphocytes on the day of immunization and 2 weeks after immunization for 11 children.


RESULTS
Only one child developed a >0.5-log increase in viral load at any time after immunization. There was no correlation between an increase in viral load and antibody response to pneumococcal vaccine. At least one activation marker increased (> 10%) for two children receiving pneumococcal vaccine and two children receiving pneumococcal and influenza vaccines. One of these children experienced an increase in viral load.


CONCLUSIONS
Immunization with pneumococcal and influenza vaccines, alone or in combination, is rarely associated with a significant increase in HIV plasma RNA in children receiving combination antiretroviral therapy.
Department of Pediatrics, UCLA School of Medicine, Harbor-UCLA Medical Center, Torrance, CA 90509, USA. keller@humc.edu
M
M
Keller
A
A
Deveikis
M
M
Cutillar-Garcia
A
A
Gagajena
K
K
Elkins
S
S
Plaeger
Y
Y
Bryson
A
A
Kaplan
K
K
Zangwill
S J
SJ
Chang
D019380:Anti-HIV Agents / Q000627:therapeutic use; D000907:Antibodies, Bacterial / Q000097:blood; D002648:Child; D002675:Child, Preschool; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology* / Q000821:virology; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D007115:Immunization Schedule; D007252:Influenza Vaccines / Q000008:administration & dosage*; D008213:Lymphocyte Activation; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D012367:RNA, Viral / Q000097:blood; D013296:Streptococcus pneumoniae / Q000276:immunology*; D019562:Viral Load
D019380:Anti-HIV Agents; D000907:Antibodies, Bacterial; D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines; D012367:RNA, Viral