Faculty Bibliography

OBJECTIVE: To evaluate the response of human immunodeficiency virus (HIV)-infected and -exposed infants to the primary series and booster dose of Haemophilus influenzae type b (Hib) conjugate vaccine. DESIGN: Retrospective study. PATIENTS AND SETTING: The HIV-exposed and -infected infants who were attending the Special Immunology Family Clinic at The Children's Hospital of Philadelphia (Pa). MAIN OUTCOME MEASURES: Geometric mean antibody titers (GMTs) to Hib polyribosyl ribitol phosphate capsular antigen were assessed after the primary series and again after the 15-month booster doses. In addition, the percentages of patients who responded with polyribosyl ribitol phosphate antibody levels greater than both 0.15 and 1.0 mg/L were compared between groups. RESULTS: After the 3-dose primary series, the GMTs were lower in the HIV-infected infants compared with those in the HIV-exposed, uninfected infants (0.86 vs 2.30, P = .02). Forty-six percent of the HIV-infected infants mounted a response ( > 1.0 mg/L) compared with that in 79% of the HIV-exposed infants (P = .05). Among the HIV-infected infants, there was no difference in the GMTs based on CD4+ cell counts or HIV-related symptoms. After the 15-month booster dose, the GMTs were not significantly different in the HIV-infected and -exposed infants. As a group, the HIV-infected infants responded to the booster dose with a 2-fold increase in the GMTs, and significantly more of these infants had antibody concentrations above 1.0 mg/L compared with their response to the primary series (62% vs 38%, P = .02). CONCLUSIONS: Most of the HIV-infected infants responded to the primary series of Hib conjugate vaccine with antibody concentrations greater than 0.15 mg/L, but the GMTs were significantly lower than those in the uninfected infants. The primary series of Hib conjugate vaccine appeared to be capable of inducing specific immunologic memory in the HIV-infected infants. The HIV-infected infants had a significant response to a booster dose of Hib conjugate vaccine, as measured by using the GMTs and the percentage of infants with antibody concentrations greater than 1.0 mg/L. The duration of protective titers will need to be followed in this population of patients who are at a high risk for serious bacterial disease

OBJECTIVE: To assess the antibody response to hepatitis B immunization in HIV-infected and uninfected infants. DESIGN: Cohort, comparing hepatitis B surface-antibody responses of HIV-infected infants with HIV-exposed but uninfected infants. SETTING: Urban children's hospital outpatient clinic for families with HIV-infected members. INTERVENTION: All infants received hepatitis B vaccine according to the American Academy of Pediatrics and Centers for Disease Control and Prevention recommended schedule. RESULTS: Forty-one HIV-exposed or infected infants were immunized with hepatitis B vaccine in the first year of life. Twenty-two out of 24 (92%) HIV-exposed but uninfected infants demonstrated an antibody response to hepatitis B immunization, compared with six out of 17 (35%) HIV-infected infants (P < 0.0005). CD4 percentage and CD4 counts were significantly lower in the HIV-infected infants than in the uninfected infants, but there was no significant difference in CD4 count or percentage between HIV-infected responders and nonresponders. CONCLUSION: The humoral immune response to hepatitis B immunization, administered before 12 months of age, is significantly reduced in HIV-infected children and is independent of CD4 count. Given the large number of infants born each year to pregnant women coinfected with HIV and hepatitis B, further studies to assess the efficacy of increased doses of antigen and variations in the dosage schedule are urgently needed

The responses to measles immunization administered between 6 and 12 months and after 12 months were compared in children with and without human immunodeficiency virus infection. No difference in response was found when primary measles immunization was administered between 6 and 12 months; however, children with human immunodeficiency virus infection had a significantly poorer response when immunization was given after 12 months. Early measles immunization should be considered in children with human immunodeficiency virus infection

A variety of arterial lesions in both pulmonary and systemic circulations have been described in association with human immunodeficiency virus infection. Such lesions include plexogenic arteriopathy in patients with primary pulmonary hypertension and fibrocalcific arterial lesions described in a variety of organs. Lesions involving the pulmonary veins, however, have not been previously described. We report a case of pulmonary veno-occlusive disease in a 2-year-old child with human immunodeficiency virus infection. In view of the rarity of these vascular disorders, including pulmonary veno-occlusive disease, it seems unlikely for their association with human immunodeficiency virus infection to occur by chance alone. Further work is needed to elucidate the role that human immunodeficiency virus may have in the pathogenesis of such vascular lesions