Authors’ reply to Kremer and Van de PerreBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1308 (Published 10 March 2015) Cite this as: BMJ 2015;350:h1308
- Nicholas J Beeching, senior lecturer (honorary consultant)1,
- Manuel Fenech, specialist trainee in infectious diseases2,
- Catherine F Houlihan, clinical research fellow3
- 1Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
- 2Royal Liverpool University Hospital, Liverpool, UK
- 3London School of Hygiene and Tropical Medicine, London, UK
Kremer and Van de Perre highlight important concerns.1 2 HIV incidence was increased mainly in men in the long term follow-up (3.5 years after vaccination) of the Phambili HIV vaccine trial, which used an adenovirus type 5 vectored DNA vaccine.3 The candidate Ebola adenovirus vectored vaccine is of a different adenovirus subtype (type 3).4 5 However, the postulated mechanism of increased HIV risk—an increase in adenovirus type specific T cells, targets for HIV that could migrate to the gut and genitalia—may still apply.
HIV-1 prevalence in young adults in the three west African countries worst affected by Ebola is estimated at 1.1% (Liberia), 1.6% (Sierra Leone), and 1.7% (Guinea), much lower than in South Africa (19.1%), where the Phambili trial was conducted (www.unaids.org/en/dataanalysis/datatools/aidsinfo). Ebola vaccine trials, including those using adenovirus vectors, should not be delayed. However, long term follow-up of study participants, including voluntary HIV counselling and testing, should be planned. Study participants should be made aware of the potential risk.3
Concern has been expressed about the effect of the Ebola outbreak on delivery of routine healthcare to people with HIV in affected countries.6 Parallels have been drawn between the stigma experienced by people living with HIV, survivors of Ebola, and healthcare workers looking after people with either infection.6 Yet there are no current data on the clinical presentation or prognosis of Ebola in people infected with HIV , including those taking antiretrovirals. It has been suggested that protease inhibitors and perhaps lamivudine have a protective effect.7 8 Survivors infected with HIV might also maintain Ebola virus in sanctuary sites, such as semen, for longer than currently described.9 Information is needed on dual infection with HIV and Ebola, and interventional studies and reports on outcomes from Ebola treatment centres in west Africa should consider this potential confounder.
Cite this as: BMJ 2015;350:h1308
Competing interests: None declared.