The effect of human immunodeficiency virus-1 infection and stunting on measles immunoglobulin-G levels in children vaccinated against measles in Uganda

Background Measles is an important public health problem in developing nati ons and there is concern that immune response to measles vaccination may be compromised by paediatric human immunodeficiency virus (HIV) infection. Th erefore, this study investigated the relationship of immunoglobulin-G (Ig-G ) antibody levels in children vaccinated against measles and HIV-1 infectio n. Further analysis was done to assess the influence of nutritional status on this relationship Methods The authors measured HIV and measles antibodies in 243 vaccinated c hildren aged 17-41 months from Kampala, Uganda. Children were from paediatr ic and HIV clinics. Potential confounders of this relationship included nut ritional anthropometric measures, age at and time since vaccination, measle s exposure, family crowding, vaccination clinic and gender. Univariable and multivariable analyses were used to study these associations. Results Fifty children (21%) were HIV infected. In univariable analysis, lo w measles antibody (<15 ELISA units/ml) was associated with HN (P = 0.05; o dds ratio (OR) = 1.86) and stunting (P = 0.06; OR = 1.68). Stunting, measur ed as height-for-age and defined as <-2 standard deviations of the referenc e population median, was a surrogate for chronic malnutrition. HIV was stro ngly associated with stunting (P = 0.0001; OR = 6.62). In multiple logistic regression, HN was not associated with low measles antibodies; however, st unting (P = 0.04; OR = 1.81), and <3 children in the home (P = 0.01; OR = 1 .96) were. Conversely, being male (P = 0.05; OR = 0.58), and measles in the home in the previous month (P = 0.04; OR = 0.33) were associated with high antibody levels. Conclusions These findings suggest that HIV in Ugandan children immunized f or measles may indirectly interfere with measles antibody levels by causing malnutrition, the latter being the direct cause. Programmes to improve chi ldhood nutrition, especially for HIV-infected children, should accompany me asles control programmes in developing nations for maximum benefit from mea sles vaccination. HIV infection per se should not change measles vaccinatio n programmes.