title: Immunity to Measles, Mumps, and Rubella in US Children With Perinatal HIV Infection or Perinatal HIV Exposure Without Infection.
abstract: BACKGROUND
  Children with perinatal human immunodeficiency virus (HIV) infection (PHIV) may not be protected against measles, mumps, and rubella (MMR) because of impaired initial vaccine response or waning immunity. Our objectives were to estimate seroimmunity in PHIV-infected and perinatally HIV-exposed but uninfected (HEU) children and identify predictors of immunity in the PHIV cohort.
  
  
  METHODS
  PHIV and HEU children were enrolled in the Pediatric HIV/AIDS Cohort Study (PHACS) at ages 7-15 years from 2007 to 2009. At annual visits, demographic, laboratory, immunization, and clinical data were abstracted and serologic specimens collected. Most recent serologic specimen was used to determine measles seroprotection by plaque reduction neutralization assay and rubella seroprotection and mumps seropositivity by enzyme immunoassay. Sustained combination antiretroviral therapy (cART) was defined as taking cART for at least 3 months.
  
  
  RESULTS
  Among 428 PHIV and 221 HEU PHACS participants, the prevalence was significantly lower in PHIV children for measles seroprotection (57% [95% confidence interval {CI}, 52%-62%] vs 99% [95% CI, 96%-100%]), rubella seroprotection (65% [95% CI, 60%-70%] vs 98% [95% CI, 95%-100%]), and mumps seropositivity (59% [95% CI, 55%-64%] vs 97% [95% CI, 94%-99%]). On multivariable analysis, greater number of vaccine doses while receiving sustained cART and higher nadir CD4 percentage between last vaccine dose and serologic testing independently improved the cumulative prediction of measles seroprotection in PHIV. Predictors of rubella seroprotection and mumps seropositivity were similar.
  
  
  CONCLUSIONS
  High proportions of PHIV-infected children, but not HEU children, lack serologic evidence of immunity to MMR, despite documented immunization and current cART. Effective cART before immunization is a strong predictor of current seroimmunity.
authors.affiliation: Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
authors.forename: George K
authors.initials: GK
authors.lastname: Siberry
authors.affiliation: Department of Epidemiology, Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Kunjal
authors.initials: K
authors.lastname: Patel
authors.affiliation: Measles, Mumps, Rubella, and Herpesviruses Laboratory Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: William J
authors.initials: WJ
authors.lastname: Bellini
authors.affiliation: Department of Epidemiology, Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Brad
authors.initials: B
authors.lastname: Karalius
authors.affiliation: Albert Einstein College of Medicine, Bronx-Lebanon Hospital Center, New York.
authors.forename: Murli U
authors.initials: MU
authors.lastname: Purswani
authors.affiliation: Boston Children's Hospital and Harvard Medical School, Massachusetts.
authors.forename: Sandra K
authors.initials: SK
authors.lastname: Burchett
authors.affiliation: Quest Diagnostics, Baltimore, Maryland.
authors.forename: William A
authors.initials: WA
authors.lastname: Meyer
authors.affiliation: Measles, Mumps, Rubella, and Herpesviruses Laboratory Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Sun Bae
authors.initials: SB
authors.lastname: Sowers
authors.affiliation: Frontier Science and Technology Research Foundation, Inc, Buffalo, New York.
authors.forename: Angela
authors.initials: A
authors.lastname: Ellis
authors.affiliation: Tulane University School of Medicine, New Orleans, Louisiana.
authors.forename: Russell B
authors.initials: RB
authors.lastname: Van Dyke
mesh_terms: D000293:Adolescent; D057134:Antibodies, Neutralizing / Q000097:blood; D000914:Antibodies, Viral / Q000097:blood*; D002648:Child; D015331:Cohort Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D015658:HIV Infections / Q000276:immunology*; D006801:Humans; D008297:Male; D008457:Measles / Q000276:immunology*; D009107:Mumps / Q000276:immunology*; D009500:Neutralization Tests; D012409:Rubella / Q000276:immunology*; D014481:United States; D010948:Viral Plaque Assay
chemical_list: D057134:Antibodies, Neutralizing; D000914:Antibodies, Viral
keywords: immunity; measles; mumps; perinatal HIV; rubella