title: Booster and higher antigen doses of inactivated influenza vaccine in HIV-infected patients.
abstract: OBJECTIVE
  To review the literature regarding booster or higher doses of influenza antigen for increasing immunogenicity of inactivated influenza vaccine (IIV) in HIV-infected patients.
  
  
  METHODS
  MEDLINE (1966 to September 2013) was searched using the terms immunize, influenza, vaccine, and HIV or AIDS in combination with two-dose, booster-dose, increased antigen, or high-dose. One trial of booster dosing with standard doses (SDs) of IIV, trivalent (IIV3); 2 trials of booster dosing with intermediate doses (ID) of H1N1 IIV or IIV3; and 1 trial of high-dose (HD) IIV3 were identified.
  
  
  METHODS
  Trials administering 2-dose, booster-dose, or increased antigen of influenza vaccine to patients with HIV were reviewed. Because adjuvanted IIV is not available and IIV, quadrivalent was recently approved in the United States, studies evaluating these vaccines were excluded.
  
  
  RESULTS
  HIV-infected individuals are at high risk for influenza-related complications; however, vaccination with SD IIV may not confer optimal protection. It has been postulated that booster or higher doses of influenza antigen may lead to increased immunogenicity. When ID and SD or ID with boosters were evaluated in HIV-infected patients, significant increases in surrogate markers for influenza protection were not achieved. However, HD IIV3 did result in significant increases in seroprotective antibody levels, though 'clinical' influenza was not evaluated.
  
  
  CONCLUSIONS
  Currently, evidence is insufficient to reach conclusions about the efficacy of booster dosing, ID, or HD influenza vaccine in HIV-infected patients. Trials evaluating booster or higher-antigen doses of IIV for 'clinical' influenza are necessary before routinely recommending for HIV-infected patients.
authors.affiliation: Virginia Commonwealth University Health System/Medical College of Virginia Hospitals, Richmond, VA, USA.
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Johnston
authors.forename: Lindsey B
authors.initials: LB
authors.lastname: Tincher
authors.forename: Denise K
authors.initials: DK
authors.lastname: Lowe
mesh_terms: D000956:Antigens, Viral / Q000008:administration & dosage*; D015658:HIV Infections / Q000628:therapy*; D006801:Humans; D007117:Immunization, Secondary; D053118:Influenza A Virus, H1N1 Subtype / Q000276:immunology; D007252:Influenza Vaccines / Q000008:administration & dosage*; D015164:Vaccines, Inactivated
chemical_list: D000956:Antigens, Viral; D007252:Influenza Vaccines; D015164:Vaccines, Inactivated
keywords: HIV; booster; high dose; immunize; increased antigen; influenza; vaccine