Immunity against diphtheria and tetanus in human immunodeficiency virus-infected Danish men born 1950-59

To evaluate the possible need for vaccination against diphtheria and tetanus of patients infected with the human immunodeficiency virus (HIV), antibodies were measured in blood samples from 78 Danish HIV-infected men, born 1950-59, who could be expected to have received primary vaccination before they contracted the HIV infection. No patients (95% confidence interval: 0-4) had tetanus antibodies below the protective level, whereas 24 of the 78 patients (16-33) were unprotected against diphtheria. In the background population of the same age group and sex, 5% and 10% have been found unprotected against tetanus and diphtheria, respectively. No relationship between disease stages and antibody levels could be found. Neither was there any difference between patients with normal and reduced numbers of CD4+ lymphocytes. From 25 patients two blood samples were taken at an interval of at least one year. Anti-tetanus titres showed a decrease comparable to that found in the background population, whereas the change in anti-diphtheria titres was more variable with rising antibody concentrations in nine patients. The fall off in antibodies did not increase with progression of the disease. It is concluded that HIV-positive younger men who have followed the vaccination program against tetanus prior to the HIV infection can be expected to be protected, whereas revaccination against diphtheria must be considered.