Abstract
HIV-infected individuals respond poorly to vaccines including the hepatitis A virus (HAV) vaccine1-6. Previous studies enorlled mostly men and although vaccine immunogenicity does not generally vary with sex7-10, some exceptions exist11-14. Female sex hormones, estrogen and progesterone, have been implicated in down regulation of inflammatory and anti-infective immune responses15,16, including increased HIV acquisition and transmission during pregnancy and in women receiving hormonal contraceptives (HC)17-22. In vitro supplementation of estrogen and progestin attenuates antiviral and autoimmune cell-mediated responses, particularly in the context of HIV infection 23-25. Furthermore, cell-mediated immunity decreases during the menstrual cycle reaching a nadir at the peak of estrogen and progesterone secretion 26. Collectively, these data indicate that female hormones may depress T-cell mediated immunity. Less is known about the effect of female hormones on antibody production. Virtually all antiviral and some antibacterial responses are T-cell dependent and may be affected by downregulation of T-cell immunity. We evaluated the effect of hormonal contraception (HC) and of CD4 cell numbers and plasma HIV RNA load on antibody responses to HAV vaccine of HIV-infected women.
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