Immunogenicity and duration of protection after yellow fever vaccine in people living with human immunodeficiency virus: a systematic review

Abstract

Background: We lack the rationale on which to base the development of a yellow fever (YF) vaccination schedule for people living with human immunodeficiency virus (PLWHIV). Objectives: To report on the current evidence regarding the seroconversion rate and the duration of humoral protection after YF vaccine, as well as the impact of revaccination in PLWHIV. Data sources: MEDLINE, Google Scholar, LILACS and Cochrane CENTRAL were searched. Methods: We selected studies on PLWHIV of all ages (including perinatally HIV-infected patients) and all settings (YF endemic and non-endemic zones). Intervention investigated was vaccination against YF, at least once after the HIV diagnosis. The research questions were the seroconversion rate, duration of humoral immunity after YF vaccine and impact of revaccination in PLWHIV. Selected studies were assessed for quality using the NewcastleeOttawa scale. Results: Ten, six and six studies were selected for the systematic review of each question, respectively. Only one study addressed the first question in perinatally HIV-infected children. The quality of the studies was assessed as Poor (n ¼ 16), Fair (n ¼ 2) or Good (n ¼ 4). A meta-analysis demonstrated that 97.6% (95% CI 91.6%e100%) of the included population seroconverted. Between 1 and 10 years after YF vaccine, reported persistence of neutralizing antibodies was 72% (95% CI 53.6%e91%), and it was 62% (95% CI 45.4%e78.6%) more than 10 years after YF vaccine. No conclusions could be drawn on impact of revaccination because of the small number of patients. Conclusions: The current evidence regarding seroconversion rate, duration of humoral protection after YF vaccine and impact of revaccination in PLWHIV is limited by the low number and quality of studies. Based on the presently available data, it is difficult to rationally develop yellow fever vaccination guidelines for PLWHIV.

Vaccination for the Prevention of Infection among Immunocompromised Patients: A Concise Review of Recent Systematic Reviews

“…Patients with hematologic cancers [ 58 ] had intermediate seroconversion rates (about 52%). Systematic reviews involving children [ 35 , 39 , 40 , 42 , 44 , 52 , 53 , 54 , 59 , 60 , 61 , 62 , 63 ] demonstrated findings consistent with those involving adults. An intervention that improved vaccine efficacy was the use of high-dose vaccines [ 35 , 37 , 42 , 44 , 45 , 51 ].…”

“…A total of 32 systematic reviews focused on non-COVID-19 vaccines ( Table 3 ). Several vaccines were studied, including inactivated hepatitis A vaccine [ 32 ], recombinant hepatitis B vaccine [ 33 , 34 , 35 , 36 , 37 , 38 ], recombinant human papillomavirus vaccines [ 39 , 40 ], inactivated influenza vaccine [ 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ], live-attenuated measles vaccine (given post hematopoietic stem-cell transplantation [ 52 ] and in children living with human immunodeficiency virus [ 53 ]), pneumococcal conjugate and polysaccharide vaccines [ 46 , 49 , 54 , 55 , 56 ], live-attenuated and recombinant subunit zoster vaccines [ 57 , 58 ], live-attenuated yellow fever vaccine [ 59 ], and others [ 60 , 61 , 62 , 63 ]. Immunocompromised states studied included use of B-cell-depleting anti-CD20 therapy, chronic kidney failure, human immunodeficiency virus infection, immune-mediated inflammatory diseases, liver cirrhosis, malignancy, post-splenectomy status, and solid organ transplant recipients.…”

“…Although a substantial number of non-COVID-19 vaccine systematic reviews contained data from children [ 35 , 39 , 40 , 42 , 44 , 52 , 53 , 54 , 59 , 60 , 61 , 62 , 63 ] (13 out of 32), none of the COVID-19 vaccine systematic reviews included pediatric studies. Furthermore, none of the systematic reviews had long-term vaccine efficacy or effectiveness results, and none were performed for oral vaccines (e.g., oral rotavirus, oral cholera, oral polio, and oral typhoid).…”

The Present and Future of Yellow Fever Vaccines

“…In a meta-analysis of studies on 17D vaccination of people living with HIV, it was found that 97.6% of the population seroconverted. Between one and 10 years after vaccination, a mean of 72% of this population still had neutralizing antibodies, and after 10 years, a mean of 62% still had neutralizing antibodies [ 50 ]. However, HIV-infected individuals who had suppressed plasma HIV RNA at the time of 17D vaccination had up to 100% seropositivity at 10 years post-vaccination, which is comparable to non-HIV-infected individuals [ 49 ].…”

A 5-year neutralizing immune response to yellow fever vaccine in HIV-infected and HIV-uninfected adults

“…Since 2013, the WHO has recommended a single dose of YFV for life-long immunity [1], but the French authorities still recommend a booster vaccination 10 years after the first dose before a new departure to an endemic area for persons living with HIV if there is no contraindication [2]. In a recent metaanalysis, 1-10 years after yellow fever vaccination, persistence of neutralizing antibodies was reported in less than 75% of HIV-infected adults [3].We prospectively studied live attenuated 17D primingvaccination in HIV-infected (HIV-positive) adults under antiretroviral therapy with CD4 þ cell counts above 350 cells/ml and HIV-uninfected (HIV-negative) adults in the ANRS EP46 NOVAA study [4]. The objective of this extended study was to evaluate the persistence of immunity for up to 5 years.…”