Sulphamethoxazole-trimethoprim: effect on antibody response in man

Immunogenicity and safety of two doses of catch-up immunization with Haemophilus influenzae type b conjugate vaccine in Indian children living with HIV

BACKGROUND

Children living with HIV are at increased risk of disease from Haemophilus influenzae type b (Hib). Data are limited on the immunogenicity of a two-dose, catch-up schedule for Hib conjugate vaccine (HibCV) among HIV-infected children accessing antiretroviral therapy (ART) late.

OBJECTIVES

The objectives of the study were to: (1) evaluate baseline immunity to Hib and the immunogenicity and safety of two doses of HibCV among HIV-infected Indian children; and (2) document the threshold antibody level required to prevent Hib colonization among HIV-infected children following immunization.

METHODS

We conducted a prospective cohort study among HIV-infected children 2-15 years of age and HIV-uninfected children 2-5 years of age. HIV-infected children received two doses of HibCV and uninfected children received one. Serum anti-Hib PRP IgG antibodies were measured at baseline and two months after immunization in the HIV-infected children. Nasopharyngeal (NP) swabs were collected at baseline and follow-up.

RESULTS

125 HIV-infected and 44 uninfected children participated. 40% of HIV-infected children were receiving ART and 26% had a viral load >100,000 copies/mL. The geometric mean concentration of serum anti-Hib PRP antibody increased from 0.25 μg/mL at baseline to 2.65 μg/mL after two doses of HibCV, representing a 10.6-fold increase (p<0.0001). 76% percent of HIV-infected children mounted an immune response. Moderate or severe immune suppression, trimethoprim/sulfamethoxazole prophylaxis, and lower baseline antibody levels were associated with lower post-vaccine serum anti-Hib PRP IgG antibodies. A serum anti-Hib PRP IgG antibody level ≥ 3.3 μg/mL was protective against Hib NP colonization. There were no differences in adverse events between HIV-infected and uninfected children.

CONCLUSION

Including a catch-up immunization schedule for older HIV infected children in countries introducing Hib vaccines is important. Older HIV-infected children with delayed access to ART and without suppressed viral loads mounted an adequate immune response following two doses of HibCV.

Side effects of antibiotics on immune response parameters and their possible implications in antimicrobial chemotherapy

Antibiotics may influence immune response by quite different ways. By screening the multitude of publications on this subject, the aim of this overview was to arrive at a basic generalizing statement on the relationship between chemical structure or mode of action of antibiotics and the effect on immune response and to get an indication on whether certain in vitro and/or ex vivo parameters could represent comparable effects under clinical conditions. - The influence of antibiotics on immune response may arise by direct effects on immunocompetent cells, i.e. in the absence of microorganisms, or indirectly by changes in structure or metabolic products of germs induced by subminimal inhibitory concentrations (subMIC's). In the former case, stimulatory and inhibitory effects have been observed on phagocytosis and intracellular killing activity, on antibody production including IgE, on different parameters of cellular immunity (e.g. foodpad swelling reaction, MIF-production, mitogen/antigen induced lymphocyte proliferation and delayed type hypersensitivity skin reaction), on mediator production as interleukins or prostaglandins and the expression of corresponding receptors on immunocompetent cells as well as on the course of experimental infections with primary resistant microorganisms. - Indirect effects are related to the influence of subMIC's of antibiotics on the morphology and structure of microorganisms, on their antigenicity/immunogenicity or on their serosensitivity and enzyme and toxin production. - This overview shows that - according to the actual knowledge - antibiotics may exhibit immunological side effects which, however, can not strictly be attributed to certain chemical structures or to a certain mode of action. - It has to be considered that a literary study comparing the results of different authors is rendered difficult by the often nonhomogeneity of experimental procedures and the fact that little is known yet about immunological side effects of antibiotics in man, i.e. under clinical conditions.

Effects of sulfamethoxazole and trimethoprim on human neutrophil and lymphocyte functions in vitro: in vivo effects of co-trimoxazole

The effects of sulfamethoxazole and trimethoprim individually and in combination on in vitro neutrophil random migration, chemotaxis to autologous endotoxin-activated serum and the synthetic chemotactic tripeptide N-formyl-L-methionyl-L-leucyl-L-phenylalanine, phagocytosis and postphagocytic Nitro Blue Tetrazolium reduction, glycolysis, hexose monophosphate shunt activity, myeloperoxidase-mediated protein iodination, hydrogen peroxide production, and degranulation were assessed. The effects on lymphocyte mitogen-induced transformation were also evaluated. It was found that the test agents individually and in combination at high concentrations (> 100 microgram/ml) caused the inhibition of neutrophil postphagocytic myeloperoxidase-mediated protein iodination, which was related to the interference with H2O2 formation as the enzyme per se was unaffected. Both agents caused the inhibition of lymphocyte transformation at high concentrations (> 100 microgram/ml). In vivo studies before and after the ingestion of co-trimoxazole by three individuals showed no inhibition of any of the neutrophil functions tested. The inhibition of lymphocyte transformation was observed in one individual after the ingestion of the chemotherapeutic agent. These findings indicate that the concentrations which inhibit neutrophil H2O2 production and lymphocyte transformation in vitro are not attainable in vivo.