title: Exploring HIV infection and susceptibility to measles among older children and adults in Malawi: a facility-based study.
abstract: BACKGROUND
  HIV infection increases measles susceptibility in infants, but little is known about this relationship among older children and adults. We conducted a facility-based study to explore whether HIV status and/or CD4 count were associated with either measles seroprotection and/or measles antibody concentration.
  
  
  METHODS
  A convenience sample was recruited comprising HIV-infected patients presenting for follow-up care, and HIV-uninfected individuals presenting for HIV testing at Chiradzulu District Hospital, Malawi, from January to September 2012. We recorded age, sex, and reported measles vaccination and infection history. Blood samples were taken to determine the CD4 count and measles antibody concentration.
  
  
  RESULTS
  One thousand nine hundred and thirty-five participants were recruited (1434 HIV-infected and 501 HIV-uninfected). The majority of adults and approximately half the children were seroprotected against measles, with lower odds among HIV-infected children (adjusted odds ratio 0.27, 95% confidence interval 0.10-0.69; p=0.006), but not adults. Among HIV-infected participants, neither CD4 count (p=0.16) nor time on antiretroviral therapy (p=0.25) were associated with measles antibody concentration, while older age (p<0.001) and female sex (p<0.001) were independently associated with this measure.
  
  
  CONCLUSIONS
  We found no evidence that HIV infection contributes to the risk of measles infection among adults, but HIV-infected children (including at ages older than previously reported), were less likely to be seroprotected in this sample.
authors.affiliation: Epicentre, Paris, France, 8 rue saint Sabin, 75011 Paris, France. Electronic address: jonathan.polonsky@epicentre.msf.org.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Polonsky
authors.affiliation: National Institute for Communicable Diseases/National Health Laboratory Service, Johannesburg, South Africa.
authors.forename: Beverley
authors.initials: B
authors.lastname: Singh
authors.affiliation: Médecins Sans Frontières, Lilongwe, Malawi.
authors.forename: Charlie
authors.initials: C
authors.lastname: Masiku
authors.affiliation: Epicentre, Paris, France, 8 rue saint Sabin, 75011 Paris, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Langendorf
authors.affiliation: Ministry of Health, Lilongwe, Malawi.
authors.forename: Matthew
authors.initials: M
authors.lastname: Kagoli
authors.affiliation: Médecins Sans Frontières, Paris, France.
authors.forename: Northan
authors.initials: N
authors.lastname: Hurtado
authors.affiliation: Médecins Sans Frontières, Paris, France.
authors.forename: Mathilde
authors.initials: M
authors.lastname: Berthelot
authors.affiliation: Médecins Sans Frontières, Paris, France.
authors.forename: Annette
authors.initials: A
authors.lastname: Heinzelmann
authors.affiliation: National Institute for Communicable Diseases/National Health Laboratory Service, Johannesburg, South Africa; Division of Virology and Communicable Diseases, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Adrian
authors.initials: A
authors.lastname: Puren
authors.affiliation: Epicentre, Paris, France, 8 rue saint Sabin, 75011 Paris, France.
authors.forename: Rebecca F
authors.initials: RF
authors.lastname: Grais
mesh_terms: D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D060085:Coinfection / Q000453:epidemiology* / Q000276:immunology / Q000821:virology; D004198:Disease Susceptibility; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007223:Infant; D008295:Malawi; D008297:Male; D008457:Measles / Q000453:epidemiology* / Q000276:immunology / Q000821:virology*; D008459:Measles virus / Q000276:immunology; D008875:Middle Aged
chemical_list: D000914:Antibodies, Viral
keywords: CD4; HIV; IgG; Malawi; Measles; Vaccination