Infants exposed to HIV at birth but not infected may have lower antibody levels

February 08, 2011

CHICAGO - In a study that included infants from South Africa, those who were exposed to human immunodeficiency virus (HIV) at birth but did not become infected had lower levels of antibodies to diseases such as pertussis, tetanus and pneumococcus, compared to infants of non-HIV infected mothers, according to a study in the February 9 issue of JAMA.

Infectious diseases account for nearly 6 million deaths worldwide annually in children younger than 5 years. Immunization against vaccine-preventable infections is essential to reducing childhood mortality. "The high prevalence of maternal HIV in many parts of the resource-poor world, coupled with successful programs to reduce mother-to-child transmission of HIV, has led to increasing numbers of HIV-exposed infants who are not HIV-infected themselves (i.e., HIV-exposed infants). These infants and children represent a vulnerable group with increased rates of lower respiratory tract infection and meningitis and up to 4-fold higher mortality in the first year of life," the authors write. "Altered immune responses might contribute to the high morbidity and mortality observed in HIV-exposed uninfected infants."

Christine E. Jones, B.M.B.S., M.R.C.P.C.H., of Imperial College London, and colleagues studied the association of maternal HIV infection with maternal- and infant-specific antibody levels to Haemophilus influenzae type b (Hib), pneumococcus, Bordetella pertussis antigens, tetanus toxoid, and hepatitis B surface antigen. The study was conducted in Khayelitsha, Western Cape Province, South Africa, between March 2009 and April 2010 and included 109 HIV-infected and uninfected women and their infants. Serum samples from 104 women and 100 infants were collected at birth and samples from 93 infants were collected at 16 weeks, with levels of specific antibodies measured.

The authors found that at birth, HIV-exposed uninfected infants (n = 46) had significantly lower specific antibody levels compared with unexposed infants (n = 54) to Hib, pertussis, pneumococcus and tetanus. Similarly, a smaller proportion of these infants had antibody levels deemed to be protective.

To investigate the mechanisms associated with infant response, the researchers measured specific maternal antibody levels: HIV-infected women (n=46) had lower specific antibody levels than uninfected women (n = 58) to Hib and pneumococcus, with no differences observed for pertussis or tetanus.

The researchers also found that HIV-exposed uninfected infants (n = 38) compared with HIV-unexposed infants (n = 55) had robust antibody responses following vaccination, with higher antibody responses to pertussis and pneumococcus.

"We were unable to correlate antibody levels with long-term vaccine responses or clinical outcomes in the women or infants. However, our data contribute to a potential explanation for the higher morbidity and mortality observed among African HIV-exposed infants," the authors write. "Our data highlight the need for larger prospective studies to determine whether the lower antibody levels in HIV-exposed infants at birth translate into increased morbidity from vaccine-preventable infections."

The researchers add that the results of their study support the evaluation of new maternal and neonatal immunization strategies to augment specific antibody responses and potentially prevent infections in infants in early life, particularly in HIV-exposed infants.
(JAMA. 2011;305[6]:576-584. Available pre-embargo to the media at

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

The JAMA Network Journals

Related HIV Articles from Brightsurf:

BEAT-HIV Delaney collaboratory issues recommendations measuring persistent HIV reservoirs
Spearheaded by Wistar scientists, top worldwide HIV researchers from the BEAT-HIV Martin Delaney Collaboratory to Cure HIV-1 Infection by Combination Immunotherapy (BEAT-HIV Collaboratory) compiled the first comprehensive set of recommendations on how to best measure the size of persistent HIV reservoirs during cure-directed clinical studies.

The Lancet HIV: Study suggests a second patient has been cured of HIV
A study of the second HIV patient to undergo successful stem cell transplantation from donors with a HIV-resistant gene, finds that there was no active viral infection in the patient's blood 30 months after they stopped anti-retroviral therapy, according to a case report published in The Lancet HIV journal and presented at CROI (Conference on Retroviruses and Opportunistic Infections).

Children with HIV score below HIV-negative peers in cognitive, motor function tests
Children who acquired HIV in utero or during birth or breastfeeding did not perform as well as their peers who do not have HIV on tests measuring cognitive ability, motor function and attention, according to a report published online today in Clinical Infectious Diseases.

Efforts to end the HIV epidemic must not ignore people already living with HIV
Efforts to prevent new HIV transmissions in the US must be accompanied by addressing HIV-associated comorbidities to improve the health of people already living with HIV, NIH experts assert in the third of a series of JAMA commentaries.

The Lancet HIV: Severe anti-LGBT legislations associated with lower testing and awareness of HIV in African countries
This first systematic review to investigate HIV testing, treatment and viral suppression in men who have sex with men in Africa finds that among the most recent studies (conducted after 2011) only half of men have been tested for HIV in the past 12 months.

The Lancet HIV: Tenfold increase in number of adolescents on HIV treatment in South Africa since 2010, but many still untreated
A new study of more than 700,000 one to 19-year olds being treated for HIV infection suggests a ten-fold increase in the number of adolescents aged 15 to 19 receiving HIV treatment in South Africa, according to results published in The Lancet HIV journal.

Starting HIV treatment in ERs may be key to ending HIV spread worldwide
In a follow-up study conducted in South Africa, Johns Hopkins Medicine researchers say they have evidence that hospital emergency departments (EDs) worldwide may be key strategic settings for curbing the spread of HIV infections in hard-to-reach populations if the EDs jump-start treatment and case management as well as diagnosis of the disease.

NIH HIV experts prioritize research to achieve sustained ART-free HIV remission
Achieving sustained remission of HIV without life-long antiretroviral therapy (ART) is a top HIV research priority, according to a new commentary in JAMA by experts at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

The Lancet HIV: PrEP implementation is associated with a rapid decline in new HIV infections
Study from Australia is the first to evaluate a population-level roll-out of pre-exposure prophylaxis (PrEP) in men who have sex with men.

Researchers date 'hibernating' HIV strains, advancing BC's leadership in HIV cure research
Researchers have developed a novel way for dating 'hibernating' HIV strains, in an advancement for HIV cure research.

Read More: HIV News and HIV Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to