Pneumococcal and influenza immunization and human immunodeficiency virus load in children

Objective. HIV-infected children receiving influenza vaccine, pneumococcal vaccine and both vaccines concurrently were studied to examine the effect o f immunization on plasma HIV viral load. Methods, Thirteen children received immunizations: pneumococcal vaccine, 5; pneumococcal and influenza vaccines, 7; and influenza vaccine, 1. Most pat ients (12 of 13) were receiving combination reverse transcriptase inhibitor antiretroviral therapy without protease inhibitors at the time of immuniza tion. Baseline plasma HIV RNA was determined 1 month prior (11 of 13), 2 we eks prior (12 of 13) and on the day of immunization (12 of 13), Plasma HIV RNA was assayed at 2 weeks (11 of 13), 4 weeks (12 of 13) and 3 months (5 o f 13) after immunization. T cell activation markers (HLA-DR+, CD38(+) and C D45RO(+), CD28(+)) were examined for both CD4(+) and CD8(+) lymphocytes on the day of immunization and 2 weeks after immunization for 11 children. Results. Only one child developed a >0.5-log increase in viral load at any time after immunization. There was no correlation between an increase in vi ral load and antibody response to pneumococcal vaccine. At least one activa tion marker increased (>10%) for two children receiving pneumococcal vaccin e and two children receiving pneumococcal and influenza vaccines. One of th ese children experienced an increase in viral load. Conclusion. Immunization with pneumococcal and influenza vaccines, alone or in combination, is rarely associated with a significant increase in HIV pl asma RNA in children receiving combination antiretroviral therapy.