Findings of a recently updated systematic review support the World Health Organization’s (WHO) recommendation that children infected with HIV should be revaccinated against measles following immune reconstitution with combination antiretroviral therapy (cART).
Use of cART has significantly prolonged the life expectancy of children infected with HIV, however, the therapy does not restore immunity induced by vaccination prior to treatment initiation. This systematic review aimed to assess existing evidence surrounding the immunogenicity of the measles vaccine in HIV-infected children and evaluate the WHO’s recommendation of revaccination.
The study authors searched PubMed, Embase, as well as Latin American and Caribbean Health Sciences databases for randomized controlled trials and cohort studies comparing the antibody responses of children who were HIV-infected, HIV-exposed but uninfected (HEU), and HIV-unexposed and uninfected (HUU) following administration of the measles vaccine. The primary endpoint of the study was serologic response to the vaccine.
The review included 12 studies with a total of 3573 children (335 HIV-infected; 788 HEU; 1478 HUU). “Four of the 12 studies found statistically significant reductions in seropositivity among HIV-infected children compared to HIV-uninfected children within 4 months of vaccination (prevalence ratio range: 0.44-0.70), and forest plots provided visual trends of decreasing immunity over time among HIV-infected children in 2 additional studies,” the study authors reported.
Additionally, in the 9 studies which evaluated vaccine safety, there were no vaccine-related deaths or serious adverse events reported.
“Although the data are limited by small numbers, heterogeneity in study designs, and potential biases, the findings support the 2015 WHO recommendation to revaccinate HIV-infected children against measles following immune reconstitution with cART,” the study authors concluded. They recommended additional studies in this patient population with longer follow-up periods.
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