title: Reduced Poliovirus vaccine neutralising-antibody titres in infants with maternal HIV-exposure.
abstract: BACKGROUND
  Maternally HIV-exposed (mHIV-EU) infants have poor health even without HIV-1 infection. The responses to vaccination are less well defined. Immunity to oral Poliovirus vaccine (OPV) was studied in Zambian infants participating in a randomised controlled trial of micronutrient fortification to improve child health.
  
  
  METHODS
  Maternally HIV-unexposed and mHIV-EU infants were recruited at 6 months age and randomised to basal or enriched micronutrient-fortified diets for 12 months. HIV-exposed mother-infant pairs had received perinatal nevirapine to prevent mother-to-child-transmission. In the cohort of 597 infants, neutralising-antibody titres to OPV were analysed at 18 months with respect to micronutrient fortification, maternal or infant HIV-1 infection, and human cytomegalovirus (HCMV) infection detected by antibodies and viraemia (serum DNA). Vaccine protection was defined as log2 titre>3.
  
  
  RESULTS
  Compared to uninfected children, HIV-1-infected children had reduced neutralising antibody titres to OPV, irrespective of diet: log2 titre difference (95% confidence interval) -3.44 (-2.41; -4.46), P<0.01. OPV antibody titres were lower in HIV-infected children with HCMV viraemia compared to those without viraemia at 18 months, but did not reach significance: difference -2.55 (-6.10; 1.01), P=0.14. Breast-feeding duration was independently associated with increasing OPV titre (P-value<0.01). In mHIV-EU children there were reduced neutralising antibody titres to Poliovirus compared with maternally HIV-unexposed, irrespective of diet, maternal education and socioeconomic status: log2 titre difference (95% confidence interval) -0.56 (-0.98; -0.15), P<0.01. This difference was noticeably decreased after adjusting for breast-feeding duration, suggesting that in our study population less breast-feeding by HIV-positive mothers could explain the reduced OPV titres in mHIV-EU infants.
  
  
  CONCLUSIONS
  The mHIV-EU infants had reduced polio vaccine antibody titres which were associated with reduced breast-feeding duration. This has important implications for polio eradication and control of vaccine-preventable diseases, in countries where childhood HIV-1 infection and maternal exposure are public health threats.
authors.affiliation: Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine, UK.
authors.forename: Marta
authors.initials: M
authors.lastname: Sanz-Ramos
authors.forename: Daniela
authors.initials: D
authors.lastname: Manno
authors.forename: Mirriam
authors.initials: M
authors.lastname: Kapambwe
authors.forename: Ida
authors.initials: I
authors.lastname: Ndumba
authors.forename: Kunda G
authors.initials: KG
authors.lastname: Musonda
authors.forename: Matthew
authors.initials: M
authors.lastname: Bates
authors.forename: Julia
authors.initials: J
authors.lastname: Chibumbya
authors.forename: Joshua
authors.initials: J
authors.lastname: Siame
authors.forename: Mwaka
authors.initials: M
authors.lastname: Monze
authors.forename: Suzanne
authors.initials: S
authors.lastname: Filteau
authors.forename: Ursula A
authors.initials: UA
authors.lastname: Gompels
mesh_terms: D057134:Antibodies, Neutralizing / Q000097:blood* / Q000276:immunology; D000914:Antibodies, Viral / Q000097:blood / Q000276:immunology*; D001942:Breast Feeding; D003586:Cytomegalovirus Infections / Q000175:diagnosis; D005260:Female; D015658:HIV Infections / Q000276:immunology / Q000635:transmission*; D006679:HIV Seropositivity / Q000097:blood / Q000276:immunology*; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical; D011051:Poliomyelitis / Q000276:immunology / Q000517:prevention & control; D017955:Poliovirus / Q000276:immunology*; D023321:Poliovirus Vaccines / Q000276:immunology*; D014611:Vaccination
chemical_list: D057134:Antibodies, Neutralizing; D000914:Antibodies, Viral; D023321:Poliovirus Vaccines