Sex: U
Vaccine: MMR
Symptoms: No therapeutic response, Vaccination failure
Clinical narrative: Literature Report: Harjot Kaur Singh, et al. Measles, Mumps, and Rubella Serostatus and Response to MMR Vaccination among HIV-Infected Adults. AIDS Patient Care and STDs, 2015, 29 (9), pgs 461-464. This literature report has been received from a published article title as stated above and refers to a retrospective study in which frequency and risk factors of MMR seronegativity, as well as MMR vaccination seroconversion were assessed. Inclusion criterion included any HIV-infected adults with MMR serostatus assessment who received sustained care at the clinic evidenced by at least two CD4 cell counts 6 months apart. MMR seroassessment was ordered at the discretion of the provider for the duration of the study period; in April 2009, measles serology was added to the new patient laboratory order set. MMR serostatus, CD4 cell counts, and plasma HIV-1 RNA levels (within 2 months of MMR seroassessment). MMR vaccination dates, demographics, and date of HIV diagnosis were abstracted. For the MMR seroconversion frequencies, MMR pre and post vaccination serostatus results closet to the vaccination date were used. MMR components were reported as immune, non-immune, or equivocal, as define by the lgG antibody levels. For analysis purposes, the non-immune and equivocal categories were combined into a category of seronegative and immune was reported asseropositive. Chi-square of Fisher's exact test were used to evaluate the association between two categorical variables and Wilcoxon Rank Sum test was used to evaluate the median differences for continuous variables between two groups. Multivariate logistic regressions were used to evaluate demographic characteristics associated with each component of MMR serostatus. The study was approved by the WCMC IRB. A total of 1491 HIV-infected adults were present who had MMR serostatus assessed over the 13 years. Measles was the most frequently ordered serology, followed by rubella and mumps (n=1311,1142, and 958 respectively). Among the 1491 patients, 31.8%, 7.7%, and 60.6% of patients had one, two, and three MMR components assessed. Measles, mumps and rubella seronegativity was 14.7,  14.4%, and 12.8%, respectively. Persons born after 1957 were more likely to be seronegative for measles (18.5% vs 4.1%, p<0.01) and rubells (14.7% vs 7.6% p>0.01), with mumps nearing statistical significance (15.2% vs 10.6%, p=0.08). Females were more likely to be rubella seronegative than males (17.9% vs. 10.5%, p<0.01). Patients seronegative for mumps and rubella had longer duration of HIV injective compared with patients who were mumps and rubella seropositive (9.1 years (4.0-14.4) vs 11.5 (6.0-169), p<0.01; 10.9 years (6.7-15.8) vs. 8.6 (3.6-13.9), p<0.01, respectively). CD4 cell cound and HN-1 RNA level were not associated with seronegativity of any MMR component. Age, gender, and  HIV duration had similar assocaitions with MMR seronegativity in the multivariable analysis. Of the 329 HIV-infected adults who were seronegative for at least one component of measles, mumps, or rubella, 173 received MMR vaccination. The median CD4 cell count was 560 cells/mm3 (IQR 388-726) and 71% (107/151) had undetectable plasma HN-1 RNA levels. Then patients were vaccinated despite having CD4 cell counts <200 cells/mm3. Among the 173 vaccines, there were 86 persons with paired pre and post vaccination serologies (40 measles, 23 mumps, 23 rubella assessments). Measles, mumps, and rubella seroconversion frequencies for individual componets were 53% (21/40), 61% (14/23), and 83% (19/23) after MMR vaccination, respectively. The median duration between MMR vaccinatioin and post vaccination serostatus combined for all three MMR components was 7.2 months (IQR 3.0-19.3). Characteristics of seroconverters and nonresponders at vaccination and post vaccination were similar. At the time of post vaccination serostatus, the medican CD4 cell count was 526 cells/mm3 (IQR440-714) and 59% had an undetectable plasma HN-1 RNA level. In longitudinal evaluation of HIV dises post vaccination, there were no statistically appreciable changes in CD4 cell counts or plasma HN-1 RNA levels at 3.6 or 12 months. Using data from a large clinic, approximately 15% were seronegativity to at least one component of MMR among adult  HN-infected patients. Based on the cumulative data, MMR vaccination does not appear to have any impact on HIV control and should not deter vaccination among at risk individuals. In conclusion, approximately 15% of HIV-infected adults were seronegative for MMR and thus eligible for MMR vaccination. Prospective studies of MMR vaccination during HIV-infected persons were needed.  This case refers to unspecified number of patients of unknown age and gender enrolled in above study. The current condition of the patient includes HIV infection. On an unknown date, the patients were vaccinated with Measles, Mumps, and Rubella vaccine (manufacturer unknown) (dose number, dose, strength, vaccination site, route unspecified). On an unknown date, the patients experienced failure fo seroconversion despite of vaccination (Vaccination failure). The outcome of the event vaccination failure was unknown. The author considered the event vaccination failure to be related to Measles, Mumps, and Rubella vaccine (manufacturer unknown). A copy of the published article is attached as further documentation of the patient's experience. Additional information has been requested.