title: Rubella immunization in human immunodeficiency virus type 1-infected children: cause for concern in vaccination strategies.
abstract: BACKGROUND
  HIV infection can have important although sometimes unexpected consequences, such as contributing to enlargement of the pool of rubella-susceptible children.
  
  
  METHODS
  At the Federal University of São Paulo, Brazil, we assessed response to rubella immunization at 15 months of age in 15 human immunodeficiency virus type 1 (HIV)-infected children, 20 seroreverted children (SR) and 18 healthy control children born to HIV-seronegative mothers (CON). Blood samples were collected before and 3 months after vaccination. All HIV-infected children had started highly active antiretroviral therapy during their first 6 months of life. Serum samples were tested with a rubella IgG enzyme-linked immunosorbent assay kit.
  
  
  RESULTS
  HIV children in immunologic categories 2/3 had lower rubella antibody titers (geometric mean, 33 IU/mL) than those from CON (125 IU/mL) and SR group (236 IU/mL) (Tukey, P = 0.01). Antibody values after vaccination were positively associated with CD4 T cell numbers and negatively associated with HIV viral load assessed immediately before vaccination. The percentage of children with protective antibodies after vaccination (above 10.0 IU/mL) was also significantly different among groups (Fisher's exact test, P = 0.013): CON, 94%; SR, 100%; HIV category 1, 100%; HIV category 2/3, 62%.
  
  
  CONCLUSIONS
  HIV-infected children with a preserved immune system at measles-mumps-rubella immunization can have a good response to rubella vaccine. In contrast, those in more advanced categories for HIV infection respond poorly.
authors.affiliation: Department of Pediatrics, Federal University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Mylena
authors.initials: M
authors.lastname: Lima
authors.forename: Regina Célia
authors.initials: RC
authors.lastname: De Menezes Succi
authors.forename: Amélia M
authors.initials: AM
authors.lastname: Nunes Dos Santos
authors.forename: Lily Yin
authors.initials: LY
authors.lastname: Weckx
authors.forename: Maria Isabel
authors.initials: MI
authors.lastname: De Moraes-Pinto
mesh_terms: D000704:Analysis of Variance; D000914:Antibodies, Viral / Q000097:blood; D001938:Brazil; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D015658:HIV Infections / Q000276:immunology*; D015497:HIV-1; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012411:Rubella Vaccine / Q000008:administration & dosage / Q000276:immunology*
chemical_list: D000914:Antibodies, Viral; D007074:Immunoglobulin G; D012411:Rubella Vaccine; C040901:rubella antibodies