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Smaller IPV dose yielded noninferior titers in HIV patients
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A 40% dose of intradermal inactivated polio vaccine achieved noninferior antibody responses in HIV patients compared with a full dose administered intramuscularly, according to the results of a randomized controlled trial.
“We conducted this study in HIV-infected adults because they have suboptimal responses to many vaccines even with well-controlled HIV infection, a finding felt to be related to chronic immune activation,” the researchers wrote in the Journal of Infectious Diseases. “Consequently, we felt that this population could function as a surrogate for populations in the developing world with suboptimal vaccine responses.” The researchers evaluated the inactivated polio vaccine (IPV) in 231 adult HIV patients with well-controlled disease (viral load<400 copies/mL) who were being treated at the Eastern Virginia Medical School HIV clinic in Norfolk, Va., between Sept. 7, 2012 and July 8, 2013.
Participants were assigned either a 40% dose (0.2 mL) intradermal IPV (n=66); a 20% dose (0.1 mL) intradermal IPV (n=66); a full-dose (0.5 mL) intramuscular IPV (n=66); or a 40% dose (0.2 mL) intramuscular IPV (n=33).
At baseline, there was 87% immunity against polio serotype 1, 90% immunity against serotype 2, and 66% immunity against serotype 3. At the follow-up visit, there was a median 64-fold increase in antibody titers. The vaccine response to 40% intradermal IPV administration was similar to that of full-dose intramuscular IPV and yielded higher antibody titers, although this increase was not significant.
More local adverse effects, such as itching or redness at the injection site, were seen with the intradermal delivery, but systemic effects such as fever or rash were low in general and did not differ significantly between groups.
According to the researchers, these findings may offer a potential option for offering the IPV vaccine to patients in developing countries.
“Intradermal IPV administration at a fractional dose higher than 20% should be considered as a means to make IPV more affordable for developing countries, balancing sufficient immunity with cost-reduction,” the researchers wrote.
Disclosure: Two of the researchers are employed by NanoPass Technologies.
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