Persistence of Depressed but Stable Levels of Pediatric Vaccine Induced Antibodies over 16 years in Perinatally HIV Infected Individuals on Combined Anti-Retroviral Therapy

BACKGROUND: The introduction of combined antiretroviral therapy (cART) markedly improved prognosis and immune competence as indicated by clinical laboratory testing. However, few data are available on the long-term durability of vaccine induced immune responses in perinatally HIV infected individuals over the two decades since cART introduction. METHODS: Perinatal HIV+, 21, on cART who had a history of MMR and/or VZV vaccinations and archived plasma samples collected at 4, 8 and 16 years after last vaccination dose were included. Samples from 11 HIV- individuals were included. Plasma IgG to measles, mumps, rubella and varicella were measured by ELISA RESULTS: The HIV+ group was in good clinical condition with respect to HIV disease (medians, 31% CD4 cells, 2.0 log (10) HIV RNA copies/ml). Levels of vaccine engendered antibodies differed markedly by HIV infection status and by vaccine. Comparison of HIV+ with HIV- antibody levels by vaccine showed the HIV+ levels were 83%*, 55%*, 13%* or 11%** (*P < 0.003, **P = 0.056 at year 16) of the levels found in HIV- for rubella, mumps, measles and VZV, respectively The patterns of relationships between HIV+ to HIV- levels of response seen at year 4 were maintained over the 12 years of observation. Over the 12 years of evaluation the antibody concentrations for each vaccine declined slowly, the apparent half-lives of vaccine specific antibodies were 96, 37, 29 and 13 years for mumps, VZV, measles and rubella, respectively. CONCLUSION: Despite being on long-term effective cART and having controlled HIV viremia and excellent levels of CD4 cells, perinatally HIV+ individuals have significantly lower levels of antibodies to VZV, measles and mumps vaccinations than HIV- adults. These reduced antibody levels were found at 4 years after immunizations and persisted with the expected slow rates of decline over the following 12 years. The data support the view that that there is an HIV associated failure in the establishment, conversion to persisting immunity phase of the responses to vaccinations. Once established antibody levels persist with near normal half-lives. DISCLOSURES: All authors: No reported disclosures.