Prevalência de soroproteção para sarampo numa coorte de adolescentes e adultos jovens vivendo com HIV e resposta vacinal após reforço de SCR nos indivíduos soronegativos
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Data
2024-03-18
Autores
Simakawa, Raquel Mayumi [UNIFESP]
Orientadores
Succi, Regina Célia de Menezes [UNIFESP]
Tipo
Dissertação de mestrado
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Resumo
Objetivos. Casos de sarampo em todo o mundo aumentaram desde 2018 devido à baixa cobertura vacinal, que diminuiu durante a pandemia de COVID-19. O estudo analisa o status sorológico de pessoas vivendo com HIV/Aids (PVHA) para o sarampo e avalia a resposta após um reforço de SCR administrado aos indivíduos soronegativos. Métodos. Estudo de coorte prospectivo com quatro grupos: 96 PVHA por transmissão vertical (v-HIV), 69 PVHA por transmissão horizontal (h-HIV), 93 controles saudáveis previamente vacinados contra sarampo (vac-CON) e 20 controles saudáveis com histórico de sarampo (dis-CON). Os anticorpos contra o sarampo foram analisados por ELISA. Uma dose extra de SCR foi oferecida aos indivíduos soronegativos e eles foram testados pelo menos 30 dias depois. Resultados. À entrada do estudo, os grupos v-HIV e h-HIV eram comparáveis em relação à última avaliação de células T CD4+ e à porcentagem de indivíduos em TARV. Por outro lado, o grupo v-HIV apresentou menores mediana de células T CD4+ e porcentagem de indivíduos em supressão virológica em comparação ao grupo h-HIV. A soropositividade para sarampo e a mediana de anticorpos foram significativamente inferiores no v-HIV em comparação aos outros três grupos (v-HIV: 58% e 159,5 UI/L x h-HIV: 95,6% e 763 UI/L x vac-CON: 94,6% e 663 UI/L x dis-CON: 100% e 1302,5 UI/L; p<0,01 e p<0,05, respectivamente). Na análise logística univariada, o nadir mais elevado de células T CD4+, o intervalo de tempo mais curto desde a última vacina contra o sarampo e a supressão virológica do HIV em qualquer dose da vacina contra o sarampo foram associados a anticorpos protetores contra o sarampo entre os indivíduos do grupo v-HIV. Na análise multivariada, apenas a supressão virológica em qualquer dose da vacina contra o sarampo foi associada a anticorpos protetores. Todos os pacientes soronegativos para sarampo responderam após o reforço de SCR. Conclusões. A supressão virológica do HIV foi associada à melhor resposta vacinal ao sarampo. Os resultados desse estudo corroboram os que recomendam um reforço de SCR à população vivendo com HIV por transmissão vertical (TV), especialmente durante a adolescência.
Objectives. Worldwide measles cases have increased since 2018 due to lower vaccination coverage, which has further declined during COVID-19 pandemic. The study analyzes people living with HIV (PWH) measles serological status and assesses response after an MMR given to seronegative individuals. Methods. Prospective cohort study with four groups: 96 PWH through vertical transmission (v-HIV), 69 PWH through horizontal transmission (h-HIV), 93 healthy controls previously vaccinated for measles (vac-CON) and 20 healthy controls with history of measles disease (dis-CON). Measles antibodies were analyzed by ELISA. An extra MMR dose was offered to seronegative individuals and they were tested at least 30 days afterwards. Results. At study entry, v-HIV and h-HIV groups were comparable regarding last CD4+ T cell assessment and percentage of individuals on ART. On the other hand, v-HIV group had lower median CD4+ T cell nadir and percentage of individuals on virological suppression compared to h-HIV group. Measles seropositivity and median antibodies were significantly lower in v-HIV compared to other three groups (v-HIV: 58% and 159.5 IU/L vs h-HIV: 95.6% and 763 IU/L vs vac-CON: 94.6% and 663 IU/L vs dis-CON: 100% and 1302.5 IU/L; p<0.01 and p<0.05, respectively). At logistic univariate analysis, higher CD4+ T cell nadir, shorter time interval since last measles vaccine and HIV virological suppression at any measles vaccine dose were associated with protective measles antibodies in v-HIV group; at multivariate analysis, only virological suppression at any measles vaccine dose was associated with protective antibodies. All measles seronegative patients responded after MMR booster. Conclusions. HIV virological suppression was associated with vaccine response to measles. The results of this study corroborate those that recommend an MMR booster for PWH through vertical transmission, especially during adolescence.
Objectives. Worldwide measles cases have increased since 2018 due to lower vaccination coverage, which has further declined during COVID-19 pandemic. The study analyzes people living with HIV (PWH) measles serological status and assesses response after an MMR given to seronegative individuals. Methods. Prospective cohort study with four groups: 96 PWH through vertical transmission (v-HIV), 69 PWH through horizontal transmission (h-HIV), 93 healthy controls previously vaccinated for measles (vac-CON) and 20 healthy controls with history of measles disease (dis-CON). Measles antibodies were analyzed by ELISA. An extra MMR dose was offered to seronegative individuals and they were tested at least 30 days afterwards. Results. At study entry, v-HIV and h-HIV groups were comparable regarding last CD4+ T cell assessment and percentage of individuals on ART. On the other hand, v-HIV group had lower median CD4+ T cell nadir and percentage of individuals on virological suppression compared to h-HIV group. Measles seropositivity and median antibodies were significantly lower in v-HIV compared to other three groups (v-HIV: 58% and 159.5 IU/L vs h-HIV: 95.6% and 763 IU/L vs vac-CON: 94.6% and 663 IU/L vs dis-CON: 100% and 1302.5 IU/L; p<0.01 and p<0.05, respectively). At logistic univariate analysis, higher CD4+ T cell nadir, shorter time interval since last measles vaccine and HIV virological suppression at any measles vaccine dose were associated with protective measles antibodies in v-HIV group; at multivariate analysis, only virological suppression at any measles vaccine dose was associated with protective antibodies. All measles seronegative patients responded after MMR booster. Conclusions. HIV virological suppression was associated with vaccine response to measles. The results of this study corroborate those that recommend an MMR booster for PWH through vertical transmission, especially during adolescence.
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Citação
SIMAKAWA, Raquel Mayumi. Prevalência de soroproteção para sarampo numa coorte de adolescentes e adultos jovens vivendo com HIV e resposta vacinal após reforço de SCR nos indivíduos soronegativos. 2024. 91 f. Dissertação (Mestrado em Pediatria e Ciências Aplicadas à Pediatria) - Escola Paulista de Medicina, , Universidade Federal de São Paulo(UNIFESP). São Paulo, 2024.