Immune response to a Tdap booster in vertically HIV-infected adolescents

• Published in: Vaccine Vol. 36; no. 37; pp. 5609 - 5616
• Main Authors: Spina, Fernanda Garcia, Gouvea, Aída, Succi, Regina Célia de Menezes, Calanca, Flavia, Weckx, Lily Yin, Terreri, Maria Teresa, Takano, Maria Aparecida Sakauchi, de Moraes-Pinto, Maria Isabel
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 05-09-2018; Elsevier Limited
• Subjects: Adolescent; Adolescents; Antibodies; Antibodies, Bacterial - blood; Antigens; Antigens, Bacterial - immunology; Antiretroviral drugs; Blood; CD4 antigen; Child; Cytokines; Cytokines - immunology; Diphtheria; Diphtheria - prevention & control; Diphtheria-Tetanus Vaccine - therapeutic use; Diphtheria-Tetanus-acellular Pertussis Vaccines - therapeutic use; Enzyme-linked immunosorbent assay; Female; Flow cytometry; Helper cells; HIV; HIV Infections - immunology; Human immunodeficiency virus; Humans; Immune response; Immune response (cell-mediated); Immune system; Immunity, Cellular; Immunity, Humoral; Immunization; Immunization, Secondary; Immunodeficiency; Immunoglobulins; Immunology; Infectious Disease Transmission, Vertical; Interleukin 10; Interleukin 13; Interleukin 4; Interleukin 5; Lymphocytes; Lymphocytes T; Male; Medical records; Pain; Pertussis; Pertussis toxin; Pregnancy; T-Lymphocytes, Helper-Inducer - immunology; Tdap; Teenagers; Tetanus; Tetanus - prevention & control; Tetanus Toxoid - immunology; Toxins; Vaccines; Vertical HIV infection; Whooping cough; Whooping Cough - prevention & control; Young Adult; γ-Interferon; Brazil; United States > US; Illinois; Tdap; Vertical HIV infection; Antibodies; Immunization; Cytokines
• ISSN: 0264-410X; 1873-2518
• DOI: 10.1016/j.vaccine.2018.07.043

•HIV adolescents on cART respond to Tdap with lower humoral and cellular immune response.•Lower immune response is mainly to diphtheria and pertussis antigens.•Virologic suppression produces a clear benefit on humoral and cellular response to Tdap.•Meningococcal tetanus toxoid conjugate vaccines might influence tetanus antibodies.
Pertussis cases have increased worldwide and knowledge on immune response and cytokine profile after Tdap vaccine in immunodeficient adolescents is scarce.
To evaluate the immune response after Tdap in HIV-infected (HIV) and in healthy adolescents (CONTROL).
Thirty HIV adolescents with CD4 cell counts >200 and 30 CONTROLs were immunized with Tdap, after a prior whole-cell DTP vaccine primary scheme. Blood samples were collected immediately before and after vaccine. Lymphocyte immunophenotyping was performed by flow cytometry; tetanus, diphtheria and pertussis toxin antibodies were assessed by ELISA; whole blood was stimulated with tetanus toxoid and Bordetella pertussis and supernatants were assessed for cytokines by xMAP.
Mean age of HIV and CONTROL groups were 17.9 e 17.1 years, respectively. Pain at injection site was more intense in CONTROL group. HIV group had similar increase in tetanus antibodies at 28 days (geometric mean concentration, GMC, 15.6; 95% CI, 7.52–32.4) than CONTROL group (GMC, 23.1; 95% CI, 15.0–35.5), but lower diphtheria antibodies at 28 days (GMC, 2.3; 95% CI, 0.88–6.19) than CONTROL group (GMC, 16.4; 95% CI, 10.3–26.2); for pertussis, the percentage of individuals who seroconverted was lower in HIV than CONTROL group (HIV, 62.1% versus CONTROL, 100%; p = .002). Both groups built a cellular immune response to tetanus, with a Th2 (IL-4, IL-5 and IL-13) and Th1 (IFN-γ) response, with lower cytokine levels in HIV than in CONTROL group. Especially for pertussis, cellular and humoral responses were less intense in HIV adolescents, with a lower Th1 and Th17 profile and higher IL-10 levels. HIV-infected adolescents on viral suppression showed an enhanced immune response to all the three vaccine antigens, although still at lower levels if compared to CONTROL group.
Both groups tolerated well and built an immune response after Tdap. However, HIV-infected adolescents would probably benefit from more frequent booster doses.