Aida de Fátima Thomé Barbosa Gouvêa, Maria Isabel de Moraes-Pinto, Maristela Miyamoto, Silvana Duarte Pessoa, Daisy Maria Machado and Regina Célia de Menezes Succi
Background: We analyzed the persistence of hepatitis A virus (HAV) antibodies 7 years after primary immunization in pediatric HIV-positive patients and its association with the immunological profile.
Methods: 29 vertically HIV-infected adolescents (median age, 12.9 years) were enrolled. All of them had been HAV-vaccinated with two HAV vaccine doses 7 years before and all had seroconverted. HAV antibodies were measured by electrochemiluminescence. Lymphocyte immunophenotyping was performed by flow cytometry. Adolescents who lost HAV antibodies were revaccinated.
Results: 23/29 patients (79.3%) persisted HAV seropositive (HAV antibodies≥20mlU/mL) 7 years after primary immunization. Age, gender, clinical progression of HIV infection, median viral load, and antiretroviral therapy were similar between those who persisted HAV seropositive and those who lost seropositivity. HIV adolescents who lost HAV antibodies had lower median CD4+ T cells/mm3 (200 vs. 634, p=0.004), lower median B cells/mm3 (103 vs. 335, p<0.001), lower median NK cells/mm3 (67 vs. 209, p=0.002), lower median percentage of naive CD4+ T cells (20% vs. 30%, p=0.026), lower median percentage of naive B cells (52% vs. 68%, p=0.009), higher median percentage of activated memory B cells (19% vs. 7%, p=0.004), higher median percentage of activated CD8+ T cells (51% vs. 22%, p=0.002), and higher median percentage of exhausted memory B cells (23% vs. 8%, p=0.031) than HAV-positive adolescents. 83.3% adolescents responded to revaccination.
Conclusion: Persistence of HAV antibodies occurred in 79.3% of patients. Both antibody maintenance and response to revaccination are closely associated with low immune activation and adequate CD4+ T and B cell levels.
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