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ORIGINAL ARTICLE  
Year : 2017  |  Volume : 10  |  Issue : 3  |  Page : 628-631
An evaluation of the effects of influenza vaccination on HIV/AIDS-stricken patients in Kermanshah Province, Western Iran


1 Centre for Communicable Disease Management, Kermanshah University of Medical Sciences, Kermanshah, Iran
2 Center for Infectious Disease Control, Ministry of Health and Medical Education, Tehran, Iran
3 Centers for Disease Control and Prevention (CDC), Kermanshah University of Medical Sciences, Kermanshah, Iran
4 Virology Department, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
5 Department of Infectious Disease, School of Medical Sciences, Kermanshah, Iran
6 Expert Advice Center for Behavioral Diseases, Kermanshah University of Medical Sciences, Kermanshah, Iran
7 Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran

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Date of Web Publication21-Aug-2017
 

   Abstract 

Background: Influenza is a contagious disease that runs a deteriorating and lethal course among high-risk groups such as HIV/AIDS patients. Influenza vaccination is significant among the high-risk groups, but there is inadequate information about vaccination among HIV/AIDS- patients. Objective: The aim of the study was investigating the effects of influenza vaccination on HIV/AIDS-stricken patients residing in Kermanshah Province, Western Iran. Materials and Methods: The present work was classified as a clinical trial. To perform the study, 134 HIV/AIDS-stricken patients were selected at the Counseling Center for Behavioral Disorders based in Kermanshah in 2014. The inclusion criteria were patients under antiretroviral treatment for at least 12 months' duration and availability of the participants in the study. 0.5 millimeters of influenza vaccine were injected into the deltoid muscles of the participants. One month before and after the injection, their blood samples were taken and stored at a temperature of –20 °C. The antibody titer tests were performed at the National Influenza Centre (NIC) based in Tehran, Iran, through the cold chain. After data collection, the SPSS Statistics 21 Software was utilized for data analysis. Results: In total 63.4% of the subjects were men and the rest (36.6) were women. The average age of the patients was 37.5 ± 8.5 years (men = 39.9±7.7 and women = 34±1.2). The results showed that the serum level of the anti-A (H1N1) antibody increased from 71.6% to 91.8% and that of the anti-B antibody went up from 70.1% to 92.5%. In addition, the results of t-test demonstrated that there was a significant difference between the levels of anti-B antibody titer and anti-A (H1N1) antibody titer before and after the influenza vaccination (P ≤ 0.05). Also, the means of CD4 and CI95% were significantly different before and after the injection (P ≤ 0.05). In this research, the CD4 count over 500 cells/mm3 rose from 22.2% to 32.8% before and after the vaccination, indicating a significant increase according to the t-test (P ≤ 0.05). Conclusion: From the presented, it can be concluded the CD4 count over 500 cells/mm3 increased after vaccination among HIV/AIDS-stricken patients. Therefore, the annual vaccination of HIV/AIDS-stricken patients against influenza can lessen the severity of pathogenicity, length of hospital stays, and mortality through stimulating the immune system and increasing the anti-Band anti-A (H1N1) antibody titers and CD4 cell counts.

Keywords: HIV, N1H1, vaccination, CD4

How to cite this article:
Gooya MM, Soroush M, Khademi N, Mokhtari-Azad T, Janbakhsh A, Yeilaghi S, Parsa S, Saeidi S, Zangeneh A. An evaluation of the effects of influenza vaccination on HIV/AIDS-stricken patients in Kermanshah Province, Western Iran. Ann Trop Med Public Health 2017;10:628-31

How to cite this URL:
Gooya MM, Soroush M, Khademi N, Mokhtari-Azad T, Janbakhsh A, Yeilaghi S, Parsa S, Saeidi S, Zangeneh A. An evaluation of the effects of influenza vaccination on HIV/AIDS-stricken patients in Kermanshah Province, Western Iran. Ann Trop Med Public Health [serial online] 2017 [cited 2019 Oct 18];10:628-31. Available from: http://www.atmph.org/text.asp?2017/10/3/628/213123



   Introduction Top


Nearly 5–10% of the world population is affected by influenza each year causing fatalities, particularly among the elderly, children, pregnant women, and people with weakened immune systems such as those with HIV/AIDS and other chronic diseases. After being infected with human immunodeficiency virus (HIV), patients become more vulnerable to the severe influenza-associated acute lower respiratory infections (ALRI).[1] Hence, annual influenza vaccination is considered a necessity among the high-risk groups by the World Health Organization with the aim of avoidance of complications and reduced length of hospital stay.

The influenza virus is easily transferred from one person to another through coughing, sneezing, and respiratory tract fluids. Influenza is the sixth leading cause of death in the world and about 30–50% of those infected with the virus display no clinical symptoms. So the best way to prevent this contagious disease is through vaccination. The U.S. Center for Disease Control and Prevention (CDC) reported that influenza vaccination can prevent 70–90% of infections among the ones aged under 60.[1] This disease usually runs a mild course with a deteriorating and lethal course among the high-risk groups such as the elderly, pregnant women, children, those suffering from the cardiovascular diseases, asthma, diabetes, cancer, and HIV/AIDS-stricken patients.[2] Therefore, WHO and CDC have stressed the importance of influenza vaccination for these high-risk groups especially those with weakened immune systems such as HIV/AIDS-stricken patients.[2] Furthermore, if HIV/AIDS-stricken patients become infected with influenza, there will be some severe complications which may be due to dysfunction of B cells among these patients especially among those with low CD4 counts and high viral loads, which can be strengthened through the influenza vaccination.[3],[4],[5],[6]

Research has shown that influenza vaccination has positive effects on those suffering from weakened immune systems, and about 60–70% of the levels of serum antibody change among HIV+ patients after receiving influenza vaccination.[7],[8] For example, in a study conducted by Nelson et al.,[9] it was reported that the level of response to influenza vaccination among HIV+ patients was almost 85–89% compared with those not infected with HIV (94–100%). Moreover, the results of an Iranian study in 2013 indicated that the levels of response to A (H1N1), A (H3N2), and anti-B antibodies were 58.5%, 67%, and 64.5%, respectively.[10]

The present study aim was to investigate the effects of influenza vaccination on HIV/AIDS-stricken patients residing in Kermanshah Province, western Iran.


   Materials and Methods Top


The present work was classified as a clinical trial. To perform the study, 134 HIV/AIDS-stricken patients were selected at the Counseling Center for Behavioral Disorders based in Kermanshah, the only center providing services to patients in western Iran, in 2014. The inclusion criteria were: patients should be under antiretroviral treatment for at least 12 months and the availability of the participants in the study. Exclusion criteria include those who were vaccinated, pregnant, or infected with tuberculosis 1 month prior to the study. In addition, all qualified participants were briefed on the goal, type of intervention, and the procedure of carrying out the study, and informed consent was obtained from all participants before the study began. Next, 5 cubic centimeters of blood were taken from each of the participants in standard conditions and were stored at a temperature of –20 °C. Further, 0.5 millimeters of influenza vaccines were injected into the deltoid muscles of the participants. All subjects were monitored for 4 weeks after the injections in terms of possible side effects of vaccination. At the end of 1 month, 5 cubic centimeters of blood were taken from each of the participants and were stored at a temperature of –20 °C. Then, to conduct the antibody titer analysis, the blood samples were delivered to the National Influenza Centre (NIC) based in Tehran, Iran, through the cold chain. After data collection, the SPSS Statistics21 Software was utilized for data analysis. The CD4 cell count was performed before and after vaccination for each of the participants in the study, and the results of serum antibody titers of influenza, CD4 cell counts, and patients' demographic data were recorded. After data collection, the SPSS Statistics21 Software was utilized for data analysis. To determine the relationship between the responses to the vaccination and the independent variables, chi-square and t-test were used. Moreover, P< 0.05 was considered significant.


   Results Top


The results of the present study revealed that 63.4% of the subjects were men and the rest (36.6) were women. The average age of the patients was 37.5 ± 8.5 years (men = 39.9 ± 7.7 and women = 34 ± 1.2). The results also showed that the serum level of the anti-A (H1N1) antibody rose from 71.6% to 91.8% and that of the anti-B antibody went up from 70.1% to 92.5%. The titers measured before and after vaccinating the participants in the study are shown in [Table 1].
Table 1: Changes of serum antibodies measured before and after vaccinating the participants

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In the present study, the protective titers greater than 40.1 were considered for inoculation of influenza.

The means of the H1N1antibody titer before and after the vaccination measured 44.3 (men = 42.6 and women = 47.3) and 160 (7) (men = 162.3 and women = 157.8), respectively. Further, the means of anti-B antibody titer before and after the vaccination measured 46.2 (men = 47.9 and women = 43.3) and 165.1 (men = 156 and women = 181.02), respectively. There was no significant difference between men and women in this regard before and after vaccination. Besides, no significant difference was observed between men and women in terms of the means of CD4 before vaccination, although there was a significant difference in this respect after the vaccination [Table 2].
Table 2: The means of antibody titer and CD4 before and after the influenza vaccination among the participants under study in terms of gender

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The results of the present study revealed that 22.2% of the HIV/AIDS-stricken patients had CD4 counts over 500 cells/mm 3 which rose to 32.8% before and after the vaccination. The difference between CD4 cells before and after the vaccination was significant [Table 3].
Table 3: The status of the distribution of CD4 among the participants under study before and after the vaccination

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   Discussion Top


Influenza is a contagious disease that runs a deteriorating and lethal course among high-risk groups such as HIV/AIDS-stricken patients. The present study was aimed at determining the responses of HIV/AIDS-stricken patients to influenza vaccination, measuring antibody titer, studying the relationship between the vaccination and CD4 among the HIV/AIDS-stricken patients, and finally predicting the appropriate measures for patients in this respect.

The results also showed that the serum level of the anti-A (H1N1) antibody rose from 71.6% to 91.8%, and that of the anti-B antibody went up from 70.1% to 92.5%. In addition, the results of t-test demonstrated that there was a significant difference between the levels of anti-B antibody titer and anti-A (H1N1) antibody titer before and after the influenza vaccination (P ≤ 0.05), which was consistent with the results of other studies.[8],[10] Additionally, the anti-B antibody titer, anti-A (H1N1)antibody titer, age, and gender of the HIV/AIDS-stricken patients were not significantly related, which was consistent with the results of an Iranian study performed by Rasoolinejad et al. (2013).[10]

The results of t-test demonstrated that there was a significant difference between the levels of anti-B antibody titer before and after the influenza vaccination. Also, a significant difference was observed between the levels of anti-A (H1N1)antibody titer before and after the influenza vaccination. However, in other studies, this figure was not significant, and contrary to the results of this study, the rise in anti-B antibody titer was not evident after vaccination.[11] Furthermore, there was a significant difference between the means of CD4 before and after the vaccination among the participants under study which was consistent with the findings of other studies.[11],[12]

One interesting point in the present study was the dramatic rise in the number of CD4 cells over 500 cells/mm 3 among the HIV/AIDS-stricken patients after the vaccination. This result was inconsistent with the results of studies indicating that the influenza vaccination had no significant effects on CD4 cell counts.[13],[14],[15] A possible reason for this might be that only subjects under antiretroviral treatment were chosen for the vaccination therefore obtaining better results. The rise of antibody titers in this study was significantly greater than those in other studies.[13],[15] The responses to influenza vaccination were affected by the antiretroviral treatment of at least 12 months' duration. Hence, it is recommended that further research be conducted in this regard.


   Conclusion Top


The annual vaccination of HIV/AIDS-stricken patients against influenza can lessen the severity of pathogenicity, length of hospital stays, and mortality through stimulating the immune system and increasing anti-B and anti-A (H1N1) antibody titers and CD4 cell counts.

Acknowledgements

Our thanks go to the highly esteemed colleagues at the National Influenza Centre (NIC) based in Tehran, Iran, as well as the personnel of the Counseling Center for Behavioral Disorders based in Kermanshah, Iran, for sample preparation and looking after the patients.

Financial support and sponsorship

Nil

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
National Foundation for Infectious Diseases. Improving influenza vaccination rates in health care Workers. In: Prevention (CDC) TCfDCa, editor. Washington, DC: Bethesda, Maryland; 2004. p. 1-21.  Back to cited text no. 1
    
2.
Influenza CS. Key Facts about Influenza (Flu) and Flu Vaccine. Centers for Disease Control and Prevention 2013.  Back to cited text no. 2
    
3.
Kunisaki KM, Janoff EN. Influenza in immunosuppressed populations: A review of infection frequency, morbidity, mortality, and vaccine responses. The Lancet Infectious Diseases 2009;9:493-504.  Back to cited text no. 3
    
4.
Cavdar C, Sayan M, Sifil A, Artuk C, Yilmaz N, Bahar H, et al. The comparison of antibody response to influenza vaccination in continuous ambulatory peritoneal dialysis, hemodialysis and renal transplantation patients. Scand J Urol Nephrol 2003;37:71-6.  Back to cited text no. 4
    
5.
Radwan HM, Cheeseman SH, Lai KK, Ellison RT. Influenza in human immunodeficiency virus-infected patients during the 1997-1998 influenza season. Clin Infect Dis 2000;31:604-6.  Back to cited text no. 5
    
6.
Zanetti AR, Amendola A, Besana S, Boschini A, Tanzi E. Safety and immunogenicity of influenza vaccination in individuals infected with HIV. Vaccine 2002;20:B29-B32.  Back to cited text no. 6
    
7.
Kroon FP, van Dissel JT, de Jong JC, Zwinderman K, van Furth R. Antibody response after influenza vaccination in HIV-infected individuals: A consecutive 3-year study. Vaccine 2000;18:3040-9.  Back to cited text no. 7
    
8.
Vigano A, Zuccotti GV, Pacei M, Erba P, Castelletti E, Giacomet V, et al. Humoral and cellular response to influenza vaccine in HIV-infected children with full viroimmunologic response to antiretroviral therapy. JAIDS J Acq Imm Def Syn 2008;48:289-96.  Back to cited text no. 8
    
9.
Nelson KE, Clements ML, Miotti P, Cohn S, Polk BF. The influence of human immunodeficiency virus (HIV) infection on antibody responses to influenza vaccines. Ann Intern Med 1988;109:383-8.  Back to cited text no. 9
    
10.
Rasoolinejad M, Jafari S, Montazeri M, Mohseni M, Foroughi M, Badie BM, et al. Antibody responses to trivalent influenza vaccine in Iranian adults infected with human immunodeficiency virus. Acta Medica Iranica 2013;51:148.  Back to cited text no. 10
    
11.
Malaspina A, Moir S, Orsega SM, Vasquez J, Miller NJ, Donoghue ET, et al. Compromised B cell responses to influenza vaccination in HIV-infected individuals. J Infect Dis 2005;191:1442-50.  Back to cited text no. 11
    
12.
Fuller JD, Craven DE, Steger KA, CoxN, Heeren TC, Chernoff D. Influenza vaccination of human immunodeficiency virus (HIV)-infected adults: Impact on plasma levels of HIV type 1 RNA and determinants of antibody response. Clin Infecti Dis 1999;28:541-7.  Back to cited text no. 12
    
13.
Madhi SA, Maskew M, Koen A, Kuwanda L, Besselaar TG, Naidoo D, et al. Trivalent inactivated influenza vaccine in African adults infected with human immunodeficient virus: Double blind, randomized clinical trial of efficacy, immunogenicity, and safety. Clin Infect Dis 2011;52:128-37.  Back to cited text no. 13
    
14.
Sullivan PS, Hanson DL, Dworkin MS, Jones JL, Ward JW, Adult, et al. Effect of influenza vaccination on disease progression among HIV-infected persons. Aids 2000;14:2781-5.  Back to cited text no. 14
    
15.
Tasker SA, Treanor JJ, Paxton WB, WallaceMR. Efficacy of influenza vaccination in HIV-infected persons: A randomized, double-blind, placebo-controlled trial. Ann Intern Med 1999;131:430-3.  Back to cited text no. 15
    

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Correspondence Address:
Nahid Khademi
Centers for Disease Control and Prevention (CDC), Kermanshah University of Medical Sciences, Kermanshah
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ATMPH.ATMPH_117_17

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