Immunogenicity and safety of yellow fever vaccination for 102 HIV-infected patients.
BACKGROUND
Yellow fever vaccine (17DV) has been investigated incompletely in human immunodeficiency virus (HIV)-infected patients, and adequate immunogenicity and safety are of concern in this population.


METHODS
In the Swiss HIV Cohort Study, we identified 102 patients who received 17DV while they were HIV infected. We analyzed neutralization titers (NTs) after 17DV administration using the plaque reduction neutralization test. NTs of 1:>or=10 were defined as reactive, and those of 1:<10 were defined as nonreactive, which was considered to be nonprotective. The results were compared with data for HIV-uninfected individuals. Serious adverse events were defined as hospitalization or death within 6 weeks after receipt of 17DV.


RESULTS
At the time of 17DV administration, the median CD4 cell count was 537 cells/mm(3) (range, 11-1730 cells/mm(3)), and the HIV RNA level was undetectable in 41 of 102 HIV-infected patients. During the first year after vaccination, fewer HIV-infected patients (65 [83%] of 78; P = .01) than HIV-uninfected patients revealed reactive NTs, and their NTs were significantly lower (P < .001) than in HIV-uninfected individuals. Eleven patients with initially reactive NTs lost these reactive NTs <or= 5 years after vaccination. Higher NTs during the first year after vaccination were associated with undetectable HIV RNA levels, increasing CD4 cell count, and female sex. We found no serious adverse events after 17DV administration among HIV-infected patients.


CONCLUSIONS
Compared with HIV-uninfected individuals, HIV-infected patients respond to 17DV with lower reactive NTs, more often demonstrate nonprotective NTs, and may experience a more rapid decline in NTs during follow-up. Vaccination with 17DV appears to be safe in HIV-infected individuals who have high CD4 cell counts, although rate of serious adverse events of up to 3% cannot be excluded.
Veit
Olivia
O
University Clinic for Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Niedrig
Matthias
M
Chapuis-Taillard
Caroline
C
Cavassini
Matthias
M
Mossdorf
Erik
E
Schmid
Patrick
P
Bae
Hi-Gung
HG
Litzba
Nadine
N
Staub
Thomas
T
Hatz
Christoph
C
Furrer
Hansjakob
H
D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000276:immunology*; D006801:Humans; D008297:Male; D009500:Neutralization Tests; D012367:RNA, Viral / Q000097:blood; D013557:Switzerland; D019562:Viral Load; D010948:Viral Plaque Assay; D015004:Yellow Fever / Q000276:immunology / Q000517:prevention & control*; D022341:Yellow Fever Vaccine / Q000009:adverse effects* / Q000276:immunology*
D000914:Antibodies, Viral; D012367:RNA, Viral; D022341:Yellow Fever Vaccine