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Open Access Highly Accessed Research article

Responses to pandemic ASO3-adjuvanted A/California/07/09 H1N1 influenza vaccine in human immunodeficiency virus-infected individuals

Deborah Kelly12, Kimberley Burt2, Bayan Missaghi23, Lisa Barrett4, Yoav Keynan56, Keith Fowke56 and Michael Grant78*

Author affiliations

1 School of Pharmacy, Memorial University of Newfoundland and Labrador, NL, St. John’s, Canada

2 Eastern Health Corporation of Newfoundland and Labrador, St. John’s, Canada

3 Division of Infectious Diseases, Memorial University of Newfoundland and Labrador, NL, St. John’s, Canada

4 National Institutes of Health Institute of Allergy and Infectious Diseases, Bethesda, MD, USA

5 Departments of Medical Microbiology and Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada

6 Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya

7 Division of BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John’s, NL, Canada

8 H1803- Immunology, Faculty of Medicine, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John’s, NL, A1B 3V6, Canada

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Citation and License

BMC Immunology 2012, 13:49  doi:10.1186/1471-2172-13-49

Published: 31 August 2012

Abstract

Background

Influenza infection may be more serious in human immunodeficiency virus (HIV)-infected individuals, therefore, vaccination against seasonal and pandemic strains is highly advised. Seasonal influenza vaccines have had no significant negative effects in well controlled HIV infection, but the impact of adjuvanted pandemic A/California/07/2009 H1N1 influenza hemaglutinin (HA) vaccine, which was used for the first time in the Canadian population as an authorized vaccine in autumn 2009, has not been extensively studied.

Objective

Assess vaccine-related effects on CD4+ T cell counts and humoral responses to the vaccine in individuals attending the Newfoundland and Labrador Provincial HIV clinic.

Methods

A single dose of ArepanrixTM split vaccine including 3.75 μg A/California/07/2009 H1N1 HA antigen and ASO3 adjuvant was administered to 81 HIV-infected individuals by intramuscular injection. Plasma samples from shortly before, and 1–5 months after vaccination were collected from 80/81 individuals to assess humoral anti-H1N1 HA responses using a sensitive microbead-based array assay. Data on CD4+ T cell counts, plasma viral load, antiretroviral therapy and patient age were collected from clinical records of 81 individuals.

Results

Overall, 36/80 responded to vaccination either by seroconversion to H1N1 HA or with a clear increase in anti-H1N1 HA antibody levels. Approximately 1/3 (28/80) had pre-existing anti-H1N1 HA antibodies and were more likely to respond to vaccination (22/28). Responders had higher baseline CD4+ T cell counts and responders without pre-existing antibodies against H1N1 HA were younger than either non-responders or responders with pre-existing antibodies. Compared to changes in their CD4+ T cell counts observed over a similar time period one year later, vaccine recipients displayed a minor, transient fall in CD4+ T cell numbers, which was greater amongst responders.

Conclusions

We observed low response rates to the 2009 pandemic influenza vaccine among HIV-infected individuals without pre-existing antibodies against H1N1 HA and a minor transient fall in CD4+ T cell numbers, which was accentuated in responders. A single injection of the ArepanrixTM pandemic A/California/07/2009 H1N1 HA split vaccine may be insufficient to induce protective immunity in HIV-infected individuals without pre-existing anti-H1N1 HA responses.

Keywords:
HIV; influenza; pandemic; A/California/07/2009 H1N1 HA antigen; AS03 oil in water adjuvant; inflammation; CD4+ T cells; age