LB-5. Lower Immunogenicity of HPV Vaccine in HIV-infected Girls aged 9-13 Years
Session: Oral Abstract Session: Late Breaker Oral Abstracts
Saturday, October 5, 2013: 11:18 AM
Room: The Moscone Center: 102 (Gateway Ballroom)
Background:

The quadravalent human papillomavirus vaccine (qHPV) is approved and recommended for use in HIV-uninfected adolescents and leads to high rates of seroconversion. There is limited information on immune responses to qHPV in HIV-infected children and adolescents. We report data from an open label, multicenter study of qHPV in HIV-infected girls and women.

Method: Participants were given 3 doses of qHPV at months 0, 2 and 6. Antibody responses pre-vaccine and post-vaccine at months 7, 12, 18 and 24, were evaluated by the Merck competitive Luminex immunoassay (cLIA) to HPV 6, 11, 16, and 18. Geometric mean titers (GMT) were calculated for girls aged 9-13 years. Results were compared to those from same-aged girls in the 3-dose arm of a 2-dose/3-dose qHPV comparative trial in HIV-uninfected girls.

Result: 

Of 407 participants in total, 27 girls aged 9-13 years were enrolled and completed the vaccine schedule per protocol. One girl was seropositive to HPV 18 at baseline; the remainder were initially seronegative to all 4 vaccine serotypes.  Mean age was 11 years; 70% were black, 4% white, and 24% other. Mean time since HIV diagnosis was 9 years with median (IQR) CD4 nadir of 470 (230-610) cells/uL. Median baseline CD4 was 710 (554-940) cells/uL, 76% were on HAART, and 62% had a suppressed viral load (VL). All girls seroconverted at month 7. Age, baseline CD4, and CD4 nadir were not correlated with GMT.  Patients with suppressed VL at baseline had approximately 2-fold higher GMT for all 4 serotypes than those with detectable VL; analysis was insufficiently powered to confirm a statistically significant difference.

 

 

 

        HIV+ Age 9-13

              HIV- Age 9-13.*

Month

HPV Type

N

GMT (95% CI)

N

GMT (95%CI)

P Value

7

16

27

4924 (3402-7128)

251

7640 (6561-8896)

<0.006

 

18

26

703 (408-1212)

252

1703 (1489-1946)

<0.001

 

6

27

844  (546-1304)

248

1856 (1571-2192)

<0.001

 

11

27

971 (642-1468)

251

2096 (1869-2350)

<0.001

* Dobson SM, et al. JAMA. 2013; 309(17):1793-1802.

Conclusion: Significantly lower peak GMT was seen in HIV-infected girls aged 9-13 years receiving qHPV compared to same-aged HIV-uninfected girls, with lower responses in those without HIV VL suppression. Durability of response, efficacy, and potential need for booster dosing need to be evaluated in this population.

Deborah Money, MD1,2, Erin Moses, MPH2, Simon Dobson, MD3, Jason C. Brophy, MD, MSc, DTM4, Sandra Blitz, MSc5, Sean Ari Bitnun, MD, MSc6, Lindy M. Samson, MD7, Normand Lapointe, MD8,9 and Sharon Walmsley, MD, FRCP10, (1)University of British Columbia, Vancouver, BC, Canada, (2)Women's Health Research Institute, Vancouver, BC, Canada, (3)British Columbia Children's Hospital, Vancouver, BC, Canada, (4)Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada, (5)University Health Network, Toronto, ON, Canada, (6)Division of Infectious Diseases, Department of Pediatrics, Hospital For Sick Children, Toronto, ON, Canada, (7)Childrens Hospital of Eastern Ontario, Ottawa, ON, Canada, (8)CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada, (9)University of Montreal, montreal, QC, Canada, (10)University of Toronto, Toronto, ON, Canada

Disclosures:

D. Money, None

E. Moses, None

S. Dobson, None

J. C. Brophy, None

S. Blitz, None

S. A. Bitnun, None

L. M. Samson, None

N. Lapointe, None

S. Walmsley, None

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