Administration of live varicella vaccine to HIV-infected children with current or past significant depression of CD4(+) T cells.
BACKGROUND
Varicella can be a severe illness in human immunodeficiency virus (HIV)-infected children. The licensed, live attenuated varicella vaccine is safe and immunogenic in HIV-infected children with minimal symptoms and good preservation of CD4(+) T cells (Centers for Disease Control and Prevention immunologic category 1).


METHODS
To study the safety and immunogenicity of this vaccine in varicella-zoster virus (VZV)-naive, HIV-infected children with moderate symptoms and/or more pronounced past or current decreases in CD4(+) T cell counts, such children (age, 1-8 years) received 2 doses of vaccine 3 months apart. The children were observed in a structured fashion for adverse events. Blood was tested for VZV antibody and VZV-specific cell-mediated immunity (CMI) at baseline, 8 weeks after each dose, and annually for 3 years. Subjects who had no evidence of immunity 1 year after vaccination received a third dose and were retested.


RESULTS
The vaccine was well tolerated; there were no vaccine-related, serious adverse events. Regardless of immunologic category, at least 79% of HIV-infected vaccine recipients developed VZV-specific antibody and/or CMI 2 months after 2 doses of vaccine, and 83% were responders 1 year after vaccination.


CONCLUSIONS
HIV-infected children with a CD4(+) T cell percentage of > or =15% and a CD4(+) T cell count of > or =200 cells/ microL are likely to benefit from receiving varicella vaccine.
Levin
Myron J
MJ
University of Colorado School of Medicine, Denver, Denver, CO 80262, USA. myron.levin@uchsc.edu
Gershon
Anne A
AA
Weinberg
Adriana
A
Song
Lin-Ye
LY
Fentin
Terrence
T
Nowak
Barbara
B
D019380:Anti-HIV Agents / Q000627:therapeutic use; D000914:Antibodies, Viral / Q000097:blood; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000166:cytology / Q000276:immunology*; D002644:Chickenpox / Q000276:immunology / Q000517:prevention & control*; D019433:Chickenpox Vaccine / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000276:immunology*; D006801:Humans; D007223:Infant; D008297:Male
D019380:Anti-HIV Agents; D000914:Antibodies, Viral; D019433:Chickenpox Vaccine