Administration of Live Varicella Vaccine to HIV‐Infected Children with Current or Past Significant Depression of CD4+ T Cells
1University of Colorado School of Medicine, Denver; 2Columbia University, New York, and 3Frontier Science and Technology Research Foundation, Amherst, New York; 4Statistical and Data Analysis Center, Harvard School of Public Health, Boston, Massachusetts
Background.
Varicella can be a severe illness in human immunodeficiency virus (HIV)–infected children. The licensed, live attenuated varicella vaccine is safe and immunogenic in HIV‐infected children with minimal symptoms and good preservation of CD4+ T cells (Centers for Disease Control and Prevention immunologic category 1).
Methods.To study the safety and immunogenicity of this vaccine in varicella‐zoster virus (VZV)–naive, HIV‐infected children with moderate symptoms and/or more pronounced past or current decreases in CD4+ T cell counts, such children (age, 1–8 years) received 2 doses of vaccine 3 months apart. The children were observed in a structured fashion for adverse events. Blood was tested for VZV antibody and VZV‐specific cell‐mediated immunity (CMI) at baseline, 8 weeks after each dose, and annually for 3 years. Subjects who had no evidence of immunity 1 year after vaccination received a third dose and were retested.
Results.The vaccine was well tolerated; there were no vaccine‐related, serious adverse events. Regardless of immunologic category, at least 79% of HIV‐infected vaccine recipients developed VZV‐specific antibody and/or CMI 2 months after 2 doses of vaccine, and 83% were responders 1 year after vaccination.
Conclusions.HIV‐infected children with a CD4+ T cell percentage of 
15% and a CD4+ T cell count of 200 cells/μL are likely to benefit from receiving varicella vaccine.
Received 22 December 2005; accepted 3 March 2006; electronically published 14 June 2006.
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Presented in part: Advisory Committee on Immunization Practices (Centers for Disease Control and Prevention), Atlanta, Georgia, 29 June 2005; International Herpesvirus Workshop VZV Satellite Symposium, Turku, Finland, 29 July 2005.
Potential conflicts of interest: M.J.L. has received research support and consultancy funds from Merck and shares with Merck a patent for a vaccine unrelated to the current study. A.A.G. has received consultancy funds from Merck and GlaxoSmithKline concerning use of varicella vaccines and has received honoraria from Merck for lectures.
Financial support: General Clinical Research Center Units, funded by the National Center for Research Resources (grant MO1RR00069 from the General Clinical Research Centers Program, National Center for Research Resources, National Institute of Allergy and Infectious Diseases [NIAID]); Pediatric AIDS Clinical Trials Group of the NIAID; Pediatric/Perinatal HIV Clinical Trials Network of the National Institute of Child Health and Human Development.
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Team members are listed after the text.