The Influence of Human Immunodeficiency Virus (HIV) Infection on Antibody Responses to Influenza Vaccines

doi:10.1059/0003-4819-109-5-383

The Influence of Human Immunodeficiency Virus (HIV) Infection on Antibody Responses to Influenza Vaccines

Abstract

Study Objective: To ascertain whether subjects infected with human immunodeficiency virus (HIV) generally develop protective hemagglutination inhibition antibody responses to inactivated influenza vaccines.

Design: Prospective study of 104 persons before and after immunization.

Setting: Outpatient clinic and hospital ward.

Patients: Persons with the acquired immunodeficiency syndrome (AIDS) (n = 25), AIDS-related complex (n = 14), and HIV-seropositive men with only lymphadenopathy or no symptoms (n = 27). Controls were HIV-seronegative homosexual men (n = 22) and HIV-seronegative heterosexuals (n = 16).

Interventions: Subjects were immunized with inactivated vaccines containing 15 μg of each of the following influenza virus hemagglutinins: A/Taiwan/1/86 (HINI), A/Mississippi/1/85(H3N2), A/Chile/1/83 (HINI), and B/Ann Arbor/1/86.

Measurements and Main Results: Fourfold or greater antibody responses occurred less frequently in subjects with HIV infections than in HIV-seronegative controls. Protective levels (1:64 or greater) of hemagglutination inhibition antibodies were attained by 94% to 100% of HIV-seronegative controls, 52% to 89% of HIV-seropositive asymptomatic subjects, and 13% to 50% of subjects with AIDS or AIDS-related complex. No increase in the prevalence or level of serum HIV p24 antigen or clinical deterioration was detected among HIV-infected persons after influenza immunization.

Conclusions: Because of the poor antibody responses to influenza vaccines among HIV-infected subjects, even in many with no or minimal symptoms, alternative strategies for preventing influenza, such as booster doses of influenza vaccine, prophylaxis with amantidine, or both should be considered.

Article and Author Information

From the Johns Hopkins University School of Hygiene and Public Health and School of Medicine, Baltimore, Maryland. For current author addresses, see end of text.
Grant Support: Partial supports by grant 1-AI-32520 from the National Institutes of Health and by a Johns Hopkins Outpatient CRC grant, RR00722.
Requests for Reprints: Kenrad E. Nelson, MD, Department of Epidemiology,School of Hygiene and Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205.
Current Author Addresses: Drs. Nelson and Polk: Departments of Epidemiology and Medicine, Johns Hopkins University School of Hygiene and Public Health and School of Medicine, Baltimore, MD 21205. Dr. Clements: Departments of International Health and Medicine, Johns Hopkins University School of Hygiene and Public Health and School of Medicine, Baltimore, MD 21205.

Dr. Miotti: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21205.

Ms. Cohn: Department of Epidemiology, Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD 21205.