Clinical and laboratory predictors of antitoxic immunity against diphtheria and tetanus in adults with HIV infection




HIV-infection, diphtheria, tetanus, immunity, adults, correlation analysis


Antiretroviral therapy has made HIV infection a chronic controlled disease, where aspects of the immunoprophylaxis of infectious diseases have acquired important clinical significance. The goal of the study was to determine the clinical and laboratory predictors of antitoxic immunity against diphtheria and tetanus in HIV-infected adults. The study included 90 HIV-infected patients aged 22 to 60 years (main group). The control group consisted of 49 immunocompetent volunteers of the corresponding age. The levels of anti-diphtheria and anti-tetanus antibodies were determined by ELISA using the diagnostic test systems RIDASCREEN Diphtheria IgG and RIDASCREEN Tetanus IgG (R-Biopharm AG, Germany). Statistical processing was performed using the licensed software product STATISTICA v.6.1. Significant differences were found between the titers of antitoxic antibodies in HIV-infected and immunocompetent adults. According to the correlation analysis, the decrease in the titers of antidiphtheria antibodies was revealed with an increase in the age of the HIV-infected patient (rs=-0.21; p=0.05). The fact of smoking (rs=-0.31; p=0.003), lowered body weight (BMI<18.5 kg/m2) (rs=-0.29; p=0.006), the presence of arterial hypertension (rs=-0.38; p<0.001), a history of bone fractures over the past 5 years (rs=-0.38; p<0.001), anemia (rs=-0.21; p=0.049), thrombocytopenia (rs=-0.44; p<0.001), accelerated ESR (rs=-0.61; p<0.001), the presence of hairy leukoplakia of the tongue (rs=-0.23; p=0.027), frequent infections caused by herpes simplex (rs=-0.52; p=0.003) and varicella zoster virus (rs=-0.34; p=0.013) are associated with low levels of antidiphtheria antibodies. A direct relationship was found between the intensity of anti-diphtheria immunity and patients receiving OST (rs=+0.54; p=0.003) and with a history of injuries with impaired skin integrity (rs=+0.31; p=0.003). Decreased anti-tetanus immunity in HIV-infected patients was also associated with smoking (rs=-0.48; p<0.001), decreased BMI (rs=-0.71; p<0.001), anemia (rs=-0.33; p=0.002), thrombocytopenia (rs=-0.75; p<0.001), a history of bone fractures over the past 5 years (rs=-0.67; p<0.001); the total number of HIV-associated opportunistic diseases (rs=-0.42; p<0.001), including the presence of oropharyngeal candidiasis (rs=-0.23; p=0.032) and hairy leukoplakia of the tongue (rs=-0.57; p<0.001), history of Herpes Zoster in the past (rs=-0.48; p<0.001), with frequent relapses of diseases caused by herpes simplex viruses (rs=-0.78; p<0.001) and repeated episodes of herpes zoster (rs=-0.74; p<0.001), as well as with pathology of the skin (rs=-0.55; p<0.001). Protective predictors of anti-tetanus antitoxic immunity strength were established: male gender (rs=+0.22; p=0.039), parenterally acquired HIV infection (rs=+0.21; p=0.05), HIV-infected patients receiving OST (rs=+0.40; p=0.041). A direct relationship was found with the decreased level of hemoglobin (rs=+0.41; p<0.001), the increase of relative number of lymphocytes in the blood (rs=+0.21; p=0.05), as well as with living in rural areas (rs=+0.40; p<0.001) and the presence of injuries with impairment of skin integrity (rs=+0.84; p<0.001). Clinical and laboratory predictors of strength of antitoxic immunity against diphtheria and tetanus in HIV-infected adults were identified, which allows us to create an individual “vaccination roadmap” for patients in this category.

Author Biographies

H. O. Revenko

SE “Dnipropetrovsk medical academy of Health Ministry of Ukraine”
V. Vernadsky str., 9, Dnipro, 49044, Ukraine

V. V. Mavrutenkov

SE “Dnipropetrovsk medical academy of Health Ministry of Ukraine” 
V. Vernadsky str., 9, Dnipro, 49044, Ukraine

Z. O. Chykarenko

SE “Dnipropetrovsk medical academy of Health Ministry of Ukraine” 
V. Vernadsky str., 9, Dnipro, 49044, Ukraine


Revenko HO, Mavrutenkov VV. [Immune res­ponse of adult people living with human immunode­ficiency virus to the introduction of diphtheria and tetanus toxoid (review of literature)]. Aktualna Infectolohia. 2018;6(1):7-11. Ukranian. doi:

Cioe PA, Melbourne K, Larkin J. An immuni­zation update for HIV-infected adults in the United States: review of the literature. J Assoc Nurses AIDS Care. 2015;26(2):201-7. doi:

Crum-Cianflone NF, Sullivan E. Vaccinations for the HIV-Infected Adult: A Review of the Current Recom­mendations, Part I. Infect Dis Ther. 2017 Sep;6(3):303-31. doi:

Mullaert J, Abgrall S, Lele N, Batteux F, Slama L.B, Meritet JF, et al. Diphtheria, tetanus, poliomyelitis, yellow fever and hepatitis B seroprevalence among HIV1-infected migrants. Results from the ANRS VIHVO vaccine sub-study. Vaccine. 2015 Sep;33(38): 4938-44. doi:

El Chaer F, El Sahly HM. Vaccination in the Adult Patient Infected with HIV: A Review of Vaccine Efficacy and Immunogenicity. Am J Med. 2019 Apr;132(4):437-46. doi:

Dlamini SK, Madhi SA, Muloiwa R, von Got­tberg A, Moosa MS, Meiring ST, et al. Guidelines for the vaccination of HIV-infected adolescents and adults in South Africa. Southern African Journal of HIV Medicine . 2018 May;19(1):1-8. doi:

Grabmeier-Pfistershammer K, Herkner H, Tou-zeau-Roemer V, Rieger A, Burgmann H, Poeppl W. Low tetanus, diphtheria and acellular pertussis (Tdap) vaccination coverage among HIV infected individuals in Austria. Vaccine. 2015 Jul;33(32):3929-32. doi:

Michel JP, Maggi S. Adult Vaccinations Changing the Immunization Paradigm. Switzerland: Springer International Publishing; 2019. 127p. doi:

Pinto Neto LFDS, Vieira JV., Ronchi NR. Vac­cination coverage in a cohort of HIV-infected patients receiving care at an AIDS outpatient clinic in Espírito Santo, Brazil. Braz J Infect Dis. 2017 Sep-Oct;21(5):515-19. doi:

Riffenburgh RH. Statistics in Medicine. 3rd ed.: Elsevier, 2012. 738p.

Sticchi L, Bruzzone B, Caligiuri P, Rappazzo E, Lo Casto M, De Hoffer L, et al. Seroprevalence and vaccination coverage of vaccine-preventable diseases in perinatally HIV-1-infected patients. Hum Vaccin Immunother. 2015 Jan;11(1):263-69. doi:

Yek C, Gianella S, Plana M, Castro P, Scheffler K, García F, et al. Standard vaccines increase HIV-1 transcription during antiretroviral therapy. AIDS. 2016 Sep 24;30(15):2289-98. doi:




How to Cite

Revenko HO, Mavrutenkov VV, Chykarenko ZO. Clinical and laboratory predictors of antitoxic immunity against diphtheria and tetanus in adults with HIV infection. Med. perspekt. [Internet]. 2020Oct.5 [cited 2024Jul.18];25(3):117-24. Available from: