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Measles linked to temporary immunosuppression in children with HIV
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WASHINGTON — Measles infection resulted in temporary but significant immunosuppression in children and adolescents with HIV who were taking antiretroviral medications, according to data presented here.
Elizabeth R. Wolf, MD, of Seattle Children’s Hospital, reported during the XIX International AIDS Conference that a decrease in CD4 count that occurs with acute measles infection may help explain the significant measles-related morbidity among children with HIV living in Botswana, South Africa, during the 2009-2010 measles epidemic, even among those with lower viral loads. However, the case fatality rate in these patients was low.
Wolf and colleagues retrospectively examined the health records of more than 2,000 children with HIV, aged 0 to 18 years, who attended the Botswana-Baylor Children’s Clinical Center of Excellence for treatment for measles infection. Measles cases were classified by a positive measles IgM or by meeting WHO clinical criteria for measles. To assess the effect of measles on CD4 percentage and log viral load, the researchers used linear regression with generalized estimating equations, which were all adjusted for age, sex, nutritional status, WHO stage, and exposure to and duration of ART.
The researchers identified 195 measles cases (45.6% male), with a median age of 13 years (interquartile range [IQR]=10.3-15.3). The baseline median CD4 percentage count was 29% (IQR=23%-35%). Of those cases, 85% were on ART, of whom 97% had viral loads of less than 400 copies/mL at baseline. Two deaths (case fatality rate = 1%) were reported as measles-related, according to investigators.
The CD4 percentage declined by 5.5 points (95% CI, 0.1-11) in the first month after measles, and at a 6-month follow-up, Wolf and colleagues found no significant difference in CD4 counts compared with baseline (P=.44).
“In patients without measles, CD4% remained stable over the entire study period. We found no significant difference in log [viral load] between pre- and post-measles visits (P=.11),” the study researchers said.
For more information:
- Wolf ER. #MOPE078. Presented at: XIX International AIDS Conference; July 22-27, 2012; Washington, D.C.
Perspective
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Richard F. Jacobs, MD
The effects of measles infection, from positive IgM serology and clinical definitions, on CD4 cell counts in HIV infected children are not surprising. The effect of many viral infections, even in normal hosts, and the modulation or impact on immune cells has been long known. The significance of this study in children controlled for nutritional status and who are on ART is that the impact on CD4 counts was measurable but transient. The authors conclude that this is an explanation for the morbidity of measles infection in HIV-infected children and adolescents. It would be just as important to see the overall low mortality rate from measles in this population and look at the positive impact of ART and the continued significance of nutrition in measles infections worldwide. The authors are to be congratulated for such a large study with important information in the global HIV community and the continued fight against measles and HIV.
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