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The Influence of Human Immunodeficiency Virus (HIV) Infection on Antibody Responses to Influenza Vaccines

Kenrad E. Nelson, MD; Mary Lou Clements, MD; Paolo Miotti, MD; Sylvia Cohn, MS; and B. Frank Polk, MD
[+] Article and Author Information

Grant Support: Partial supports by grant 1-AI-32520 from the National Institutes of Health and by a Johns Hopkins Outpatient CRC grant, RR00722.

Requests for Reprints: Kenrad E. Nelson, MD, Department of Epidemiology,School of Hygiene and Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205.

Current Author Addresses: Drs. Nelson and Polk: Departments of Epidemiology and Medicine, Johns Hopkins University School of Hygiene and Public Health and School of Medicine, Baltimore, MD 21205. Dr. Clements: Departments of International Health and Medicine, Johns Hopkins University School of Hygiene and Public Health and School of Medicine, Baltimore, MD 21205.

Dr. Miotti: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21205.

Ms. Cohn: Department of Epidemiology, Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD 21205.


©1988 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1988;109(5):383-388. doi:10.7326/0003-4819-109-5-383
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Study Objective: To ascertain whether subjects infected with human immunodeficiency virus (HIV) generally develop protective hemagglutination inhibition antibody responses to inactivated influenza vaccines.

Design: Prospective study of 104 persons before and after immunization.

Setting: Outpatient clinic and hospital ward.

Patients: Persons with the acquired immunodeficiency syndrome (AIDS) (n = 25), AIDS-related complex (n = 14), and HIV-seropositive men with only lymphadenopathy or no symptoms (n = 27). Controls were HIV-seronegative homosexual men (n = 22) and HIV-seronegative heterosexuals (n = 16).

Interventions: Subjects were immunized with inactivated vaccines containing 15 μg of each of the following influenza virus hemagglutinins: A/Taiwan/1/86 (HINI), A/Mississippi/1/85(H3N2), A/Chile/1/83 (HINI), and B/Ann Arbor/1/86.

Measurements and Main Results: Fourfold or greater antibody responses occurred less frequently in subjects with HIV infections than in HIV-seronegative controls. Protective levels (1:64 or greater) of hemagglutination inhibition antibodies were attained by 94% to 100% of HIV-seronegative controls, 52% to 89% of HIV-seropositive asymptomatic subjects, and 13% to 50% of subjects with AIDS or AIDS-related complex. No increase in the prevalence or level of serum HIV p24 antigen or clinical deterioration was detected among HIV-infected persons after influenza immunization.

Conclusions: Because of the poor antibody responses to influenza vaccines among HIV-infected subjects, even in many with no or minimal symptoms, alternative strategies for preventing influenza, such as booster doses of influenza vaccine, prophylaxis with amantidine, or both should be considered.

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