Changes in Measles Serostatus Among HIV-infected Zambian Children Initiating Antiretroviral Therapy Before and After the 2010 Measles Outbreak and Supplemental Immunization Activities

• Published in: The Journal of infectious diseases 2013-12, Vol.208 (11), p.1747-1755
• Main Authors: Rainwater-Lovett, Kaitlin, Nkamba, Hope C., Mubiana-Mbewe, Mwangelwa, Bolton-Moore, Carolyn, Moss, William J.
• Format: Article
• Language: English
• Subjects: Antibodies; Antibodies, Viral - blood; Antiretroviral Therapy, Highly Active; Antiretrovirals; Applied microbiology; Biological and medical sciences; Child; Child development; Child, Preschool; Children; Cohort Studies; Disease Outbreaks; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Highly active antiretroviral therapy; HIV; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - immunology; HIV-1 - immunology; HIV/AIDS; Human immunodeficiency virus; Human viral diseases; Humans; Immunization, Secondary; Immunoglobulin G - blood; Infant; Infectious diseases; Major and Brief Reports; Male; Measles; Measles - epidemiology; Measles - immunology; Measles - prevention & control; Measles Vaccine - administration & dosage; Measles Vaccine - immunology; Measles virus; Measles virus - immunology; Medical sciences; Microbiology; Prospective Studies; Seroepidemiologic Studies; T lymphocytes; Vaccination; Vaccines, antisera, therapeutical immunoglobulins and monoclonal antibodies (general aspects); Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye; Viral Load; Zambia - epidemiology
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1093/infdis/jit404

Background. In 2010, Zambia had a large measles outbreak, providing an opportunity to measure changes in measles serostatus following highly active antiretroviral therapy (HAART), exposure to measles virus, and revaccination among children infected with human immunodeficiency virus (HIV). Methods. A prospective cohort study of 169 HIV-infected Zambian children aged 9-60 months with a history of measles vaccination was conducted to characterize the effects of HAART and revaccination on measles immunoglobulin G (IgG) serostatus by enzyme immunoassay. Results. Prior to the measles outbreak, only 23% of HIV-infected children were measles IgG seropositive at HAART initiation. After adjusting for 6-month changes in baseline age and 5% changes in nadir CD4⁺ T-cell percentage, HAART was not associated with measles IgG seroconversion. However, 18 of 19 children seroconverted after revaccination. Eight children seroconverted during the outbreak without revaccination and were likely exposed to wild-type measles virus, but none were reported to have had clinical measles. Conclusions. Immune reconstitution after HAART initiation did not restore protective levels of measles IgG antibodies, but almost all children developed protective antibody levels after revaccination. Some previously vaccinated HIV-infected children had serological evidence of exposure to wild-type measles virus without a reported history of measles.