Publications (2)4.56 Total impact
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ABSTRACT: In HIV-infected patients, data on immunogenicity of Yellow fever immunization are scarce, and there is conflicting evidence of the influence of CD4 T-cell count and plasma HIV RNA on neutralizing antibody titer (NT) after vaccine injection. In this prospective cohort study, NT was measured in all consecutive HIV outpatients who had previously received at least 1 injection of Yellow fever vaccine. Risk factors for vaccine failure (NT < 1:10) and magnitude of NT according to dates of HIV diagnosis and immunization were assessed by logistic regression and general linear models. Among 364 included patients, 24 (7%) had NT <1:10 after a mean delay of 8.4 years after immunization. Among patients immunized after HIV diagnosis (n = 240), NT <1:10 was associated only with detectable plasma HIV RNA at immunization. Among 79 patients with primary vaccination after diagnosis of HIV infection, higher HIV RNA at immunization was the unique independent risk factor for NT <1:10 [adjusted odds ratio (OR) = 3.73 per log10, 95% confidence interval (CI): 1.14 to 12.28]. Lower values of NT were independently associated with a shorter duration of undetectable plasma HIV RNA (OR = 1.05 per year, 95% CI: 1.005 to 1.09) and higher plasma HIV RNA (OR = 0.91 per log10, 95% CI: 0.84 to 0.99) at immunization. The key determinant of antibody response was the HIV replication status at immunization. No association was found between antibody response and CD4 T-cell count.
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ABSTRACT: Background: HIV-infected patients often travel in tropical areas where immunization against Yellow Fever is compulsory. There are no data about its efficacy and safety in the 2007-2008 era, where patients are mostly treated and with controlled immunosuppression. Methods: A cohort study including all consecutive HIV-patients immunized against Yellow Fever was conducted in our Travel Medicine Department between January 2003 and August 2007. Efficacy was assessed by measurement of neutralizing antibody response in serum (Pasteur Cerba, France) between October 2007 and February 2008. Titer ≥ 1/10 was defined as protective. CD4-T cell counts and plasma HIV-RNA were collected at time of immunization and serum control. Log-transformed titer was used to assess spearman ranked sum test correlation between antibody level and 1) CD4 cells count at time of immunization and of serology, 2) delay between immunization and serology. Results: 103 patients were included (75% ARV-treated). At time of immunization, mean CD4-T cell count was 490/mm3 (range: 16-1254) and median plasma HIV-RNA was1.60 log10 copies/mL (58% < 40 copies/ml). Mean interval from immunization to serology was 784 days (range: 57-1778). At time of serology, mean CD4-T cell count was 511/mm3 (range: 14-1523). All patients except one developed a protective antibody response (median titer: 1/40; range: 1/5-1/80), including the 6 patients with a CD4-T cell count under 200/mm3 at time of serology. A negative correlation between antibody titer and interval from immunization to serology control was noted (p=0.034). No correlation was found between antibody titer and CD4-T cell count at immunization or serology. No adverse event was reported. Discussion: Yellow Fever vaccination was found to be safe and effective in this cohort of non severely immunocompromised HIV-infected patients. Antibody response was dependent of time elapsed since immunization, but not of CD4-T cell count. This supports the large use of vaccination in HIV-infected patients who travel to endemic countries.