Association of CMV, HBV, or HCV co-infection with vaccine response in adults with well-controlled HIV infection

Abstract

Even after CD4 count recovery on antiretroviral therapy, HIV infection is associated with decreased response to most vaccines compared to the general population. Chronic infections with viruses such as cytomegalovirus (CMV), hepatitis B virus (HBV), and hepatitis C virus (HCV), which are more prevalent in HIV-infected populations, have been linked to immune dysfunction and decreased vaccine response in the general population. However, whether co-infection with these other viruses contributes to the decreased vaccine response seen in adults with well-controlled HIV infection is unknown. We conducted a secondary analysis of data and serum from adults with well-controlled HIV infection from an inactivated polio vaccine trial (224 subjects) and a pneumococcal conjugate vaccine study (128 subjects). We evaluated the association of CMV, HBV, or HCV co-infection with post-vaccination antibody levels using both univariate and multivariate analyses, controlling for factors such as age, race, CD4 count, comorbidities, smoking status, and baseline antibody levels. Ninety-three percent, 7%, and 14% of subjects were co-infected with CMV, HBV, and HCV respectively. On both univariate and multivariate analysis, neither CMV nor HCV co-infection were significantly associated with post-vaccination antibody levels to either vaccine. HBV co-infection was significantly associated with post-vaccination antibody concentrations for pneumococcal serotype 7F on univariate analysis and 6A on multivariate analysis, but the association was with higher antibody concentrations. In conclusion, co-infection with CMV, HBV, or HCV does not appear to contribute to the decreased vaccine response seen in adults with well-controlled HIV infection.

Keywords: CMV; HBV; HCV; HIV; vaccine response.

Figure 1.

Polio neutralizing antibody geometric mean titer (GMT) for each serotype (1, 2, and 3) grouped by CMV, HBV, and HCV coinfection status for adults with well-controlled HIV infection. 1a shows the GMTs prior to an inactivated polio vaccine booster, and 1b shows the GMTs one month after receiving the booster. Bars represent 95% confidence intervals.

Figure 2.

Pneumococcal antibody geometric mean concentration (GMC) for each of 4 serotype (3, 6A, 7F, and 19A) grouped by CMV, HBV, and HCV coinfection status for adults with well-controlled HIV infection. 2a shows the GMCs prior to vaccination, and 2b shows the GMCs one month after receiving the pneumococcal conjugate vaccine Prevnar 13. Bars represent 95% confidence intervals.