Influenza vaccination of human immunodeficiency virus (HIV)-infected adults: Impact on plasma levels of HIV type 1 RNA and determinants of antibody response

We assessed the effect of influenza vaccination on plasma levels of human i mmunodeficiency virus type 1 (HIV-1) RNA and the impact of age, plasma HIV- 1 RNA level, CD4 cell count, and anti-HIV therapy on immune response. Forty -nine adults (mean age, 38.7 years; mean CD4 cell count +/-SD, 190 +/- 169/ mL; mean plasma HIV-1 RNA level +/- SD, 154,616 +/- 317,192 copies/mL) were immunized. Elevations of greater than or equal to 0.48 log in plasma HIV-1 RNA levels occurred in two (4%) of 49 subjects within 4 weeks of vaccinati on. A fourfold or greater increase in antibody titer occurred in 13 (45%) o f 29 subjects, correlating directly with CD4 cell count (P =.002) and inver sely with plasma HIV-1 RNA level (P =.034), By multivariate analysis, CD4 c ell count was a stronger predictor of antibody response than was plasma HIV -1 RNA level. We conclude that increases in plasma HIV-1 RNA levels followi ng influenza vaccination are rare and transient and that antibody response is impaired with CD4 cell counts of <100/mL and plasma HIV-1 RNA levels of > 100,000 copies/mL, Prospective trials are needed to evaluate the impact o f highly active therapy on immune response after vaccination.