Many HIV-Infected Children Lack Immunity to Measles, Mumps

Children vaccinated before starting HIV therapy found to be at risk.

In addition to the difficulties of managing HIV, individuals who were infected around the time of birth may also have myriad other health concerns to deal with, a recent study indicates.

An analysis by the National Institutes of Health (NIH) and the US Centers for Disease Control and Prevention finds that up to one-half of individuals nationwide who were HIV-positive around the time of birth may lack immunity to measles, mumps, and rubella, despite having been vaccinated against those diseases. The findings are based on an analysis of more than 600 patients who were exposed to HIV in utero.

“Having a high level of immunity to measles, mumps, and rubella is important not only for an individual’s health, but also for preventing disease outbreaks in the larger community,” said study first author George K. Siberry, MD. “Individuals infected with HIV at birth who did not have the benefit of combined antiretroviral therapy before they were vaccinated should speak with their physician about whether they need a repeated course of the vaccine.”

The study included children aged from 7 to 15 years across the United States and Puerto Rico, as part of an evaluation of individuals exposed to HIV in the womb. Investigators analyzed serum specimens from patients for antibodies against measles, mumps, and rubella.

Included were 428 children in the perinatally HIV-infected group (PHIV) and 221 uninfected children whose mothers had HIV in the HIV-exposed but uninfected (HEU) group. Many children in the PHIV group were born prior to 1996, when modern anti-HIV regimens in combination with antiretroviral therapy gained prominence.

Approximately 93% of children in both groups received at least the recommended 2 doses of the measles, mumps, and rubella vaccine (MMR). The recommended schedule for MMR calls for doses administered at 12 to 15 months, and again between the ages of 4 to 6 years.

Children in the PHIV group were, on average, significantly less likely to have protective levels of protective antibodies for the measles, mumps, and rubella than children in the HEU group. Meanwhile, children in the PHIV group treated with combined antiretroviral therapy prior to receiving MMR vaccine were more likely to have protective levels of antibodies for the 3 diseases, especially in children with higher levels of CD4+ cells at the time of vaccination.

The study noted as a result of older children who are representative of the PHIV population in the United States, many other PHIV youth could potentially lack adequate protection against measles, mumps, and rubella.

It was subsequently recommended that individuals administered MMR vaccinations before the combined antiretroviral therapy became common should consult a physician to determine if an additional 2 doses of the vaccine is necessary.