Risk Factors for Measles Seronegativity in HIV

Measles, blood test
Measles, blood test
Considering the resurgence of measles in Europe and the risk of severe complications associated with the infection, individuals with HIV born after 1970 or those who were vertically infected should be tested for measles-specific IgG, irrespective of ethnic background or migration status.

Risk factors associated with being seronegative for measles in a cohort of HIV-infected subjects were found to be a birth date after 1970 and vertically transmitted HIV infection, according to a short communication in the journal HIV Medicine.1

All individuals with HIV in the Brussels Saint-Pierre cohort who had a measles serologic test performed between March 2005 and May 2017 were identified retrospectively. Immunoglobulin G (IgG) titer >275 mIU/mL was considered protective in this analysis, and logistic regression was used to analyze risk factors.

Of the 3124 individuals in the cohort, measles serology was available in 273 individuals in active follow-up. The prevalence of seronegativity was 21.6%, and both being born after 1970 and acquiring HIV infection by vertical transmission were associated with a higher risk of measles seronegativity using univariate analysis. A nadir CD4 T-cell count <200 cells/µL was associated with a lower risk.

In the multivariate analysis, being born after 1970 (odds ratio [OR] 4.9; 95% CI, 1.3-18.7) and vertical transmission (OR 7.7; 95% CI, 3.3-18.3) were significantly associated with measles seronegativity.

The lack of protection from measles found in this study may be an overestimation due to the retrospective study design; however, 2 risk factors were found to be associated with seronegativity. In light of the resurgence of measles in Europe, these represent target groups for the testing for measles-specific IgG. Vertically infected patients represented 36.2% of those found to be seronegative despite evidence of previous vaccination with a median of 2 doses, and some studies indicate that revaccination with an additional dose allowed for seroconversion.2,3 However, retesting of these patients after revaccination is recommended. Other groups of HIV-infected individuals may also benefit from regular testing, but this needs to be confirmed with further research.

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  1. Dauby N, Martin C, Hainaut M, et al. Prevalence and risk factors of measles seronegativity in a cohort of HIV-positive subjects: a retrospective study [published online March 24, 2018]. HIV Med. doi: 10.1111/hiv.12610
  2. Newman LP, Njoroge A, Magaret A et al. Sustained responses to measles revaccination at 24 months in HIV-infected children on antiretroviral therapy in Kenya. Pediatr Infect Dis J. 2017;36:1148-1155.
  3. Aurpibul L, Puthanakit T, Sirisanthana T, Sirisanthana V. Persistence of measles, mumps, and rubella protective antibodies 3 years after revaccination in HIV-infected children receiving antiretroviral therapy. Clin Infect Dis. 2010;50:1415-1418.