Similar Measles Seroprevalence in People With and Without HIV

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The reviewed studies did not support the need for an additional dose of measles-containing vaccines in all people with HIV, which contradicts the WHO guidelines for children.
The reviewed studies did not support the need for an additional dose of measles-containing vaccines in all people with HIV, which contradicts the WHO guidelines for children.

A systematic review, published in Clinical Infectious Diseases, found similar measles seroprevalence in people living with HIV and adolescents and adults who do not have HIV, suggesting that PLWHIV do not need an additional dose of a measles vaccine.

A search of Medline (Ovid), Embase, Cohrane Library, PubMed, LILACS, INDMED, AIM, and the World Health Organization (WHO) Global Index Medicus databases yielded 30 studies that met the inclusion criteria. Measles seroprevalence was high across studies: a median of 92% in 27 studies. Researchers found that there were no significant differences between seroprevalence in PLWHIV compared with people who do not have HIV. In 6 studies that evaluated the efficacy of measles-containing vaccines in seronegative adults who did not have HIV, measles seropositivity ranged from 0% to 56%, with a median of 39%. Researchers noted that the efficacy of measles-containing vaccines improved in studies conducted after the introduction of antiretroviral therapy (ART) in 1994. There were no severe adverse events reported in patients with HIV after receiving vaccines.   

This study was limited by substantial heterogeneity in study design and study populations, which resulted in inconsistent participant-level information. There was also inconsistent reporting of some variables across the studies reviewed, such as ART coverage, previous vaccination, measles history, and a history of AIDS-defining illness, which prevented the pooling of data. The study authors also noted that enzyme-linked immunosorbent assay-based testing has been shown to underestimate measles humoral immunity, especially in patients with low antibody levels, meaning seroprevalence and vaccine immunogenicity could potentially be higher in both infected and uninfected individuals.

Current WHO guidelines recommend an additional dose of measles-containing vaccine for children with HIV receiving highly active antiretroviral therapy (HAART) after immune reconstitution. Researchers concluded that the similarities in seroprevalence found in the reviewed studies “do not support the need for an additional dose of measles-containing vaccines in all [people with HIV],” which contradicts the WHO guidelines for children. However, according to the study authors, the results did support WHO guidelines that recommend measles vaccines be given to potentially susceptible, asymptomatic adults living with HIV and can be considered in patients with symptomatic infections if they are not severely immunosuppressed.

Reference

Loevinsohn G, Rosman L, Moss WJ. Measles seroprevalence and vaccine responses in HIV-infected adolescents and adults: A systematic review [published online November 17 2018]. Clin Infect Dis. doi:10.1093/cid/ciy980

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