human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND To determine the rate of seroconversion after 2 doses of a novel split virion , inactivated , adjuvanted p and emic H1N1 influenza vaccine ( A/California/7/2009 ) in human immunodeficiency virus type 1 (HIV-1)-infected patients ( Clinical Trials.gov NCT01017172 ) . METHODS Diagnostic study of adult HIV-1-infected patients scheduled for H1N1 influenza A vaccination .  Blood sample s where taken before and 21 days after the first dose and 21 days after the second dose of the vaccine . Antibody ( AB ) titers were determined by hemagglutination inhibition assay . Seroconversion was defined by either an AB titer ≤ 1:10 before and ≥ 1:40 after or ≥ 1:10 before and a ≥ 4-fold increase in AB titer 21 days after vaccination . RESULTS One hundred thirty-five patients received 2 doses of the H1N1 vaccine and were analyzed . The rate of seroconversion was 68.2 % ( 95 % confidence interval , 59.6 - 75.9 ) after the first dose and 91.9 % ( 95 % confidence interval , 85.9 - 95.9 ) after the second dose . Patients who did not seroconvert had a lower mean nadir CD4 cell count ( ± st and ard deviation ; 81 ± 99 vs 190 ± 148 cells/μL ; P = .006 ) , had a longer duration of HIV infection ( ± st and ard deviation ; 13.1 ± 5.9 vs 8.8 ± 6.8 years ; P = .04 ) , and were more likely to have an AB titer ≥ 1:40 before vaccination ( 4 % vs 55 % ; P < .001 ) when compared with patients with seroconversion . No other differences were found between the 2 groups , including AIDS status , highly active antiretroviral therapy status , HIV RNA - polymerase chain reaction load < 50 copies/mL , CD4 cell count , sex , body mass index , and chronic hepatitis . CONCLUSION Among HIV-infected patients , the rate of seroconversion after the first dose of an adjuvanted H1N1 influenza A vaccine was 68 % and increased to 92 % after a second doses BACKGROUND There are , to our knowledge , no prospect i ve studies of respiratory tract infections in human immunodeficiency virus (HIV)-infected adults in the highly active antiretroviral therapy ( HAART ) era . We performed a surveillance study of out patients who presented with fever and respiratory symptoms to examine the role of viral pathogens in these patients . METHODS Consecutive patients with a temperature of > 38.0 degrees C and respiratory symptoms were recruited from a tertiary care HIV clinic during the period 2003 - 2006 . Nasal pharyngeal sample s were tested for influenzavirus A and B , respiratory syncytial virus , and human metapneumovirus using real-time multiplex polymerase chain reaction assays . Paired acute- and convalescent-phase serum sample s were tested for respiratory viruses by complement fixation . RESULTS Fifty patients ( 90 % of whom were receiving HAART ) were included in the study ( median CD4(+ ) T cell count , 325 cells/microL ; median HIV RNA level , < 50 copies/mL ) . A causative pathogen was identified in 25 patients ( 50 % ) . Even though 76 % of subjects had received influenza vaccine , viral infections were diagnosed in 21 patients ( 42 % ) , as follows : influenza A , 10 patients ; influenza B , 10 ; and parainfluenza virus type 3 infection , 1 . Patients with and those without viral infection had similar demographic characteristics and HIV statuses . No patients with influenza and 23 % of patients with other conditions had radiography-confirmed pneumonia ( P=.07 ) . Antibiotic prescriptions were common : 70 % of patients received antibiotics . No patients with influenza required hospitalization , compared with 21 % of other patients ( P=.03 ) . CONCLUSIONS Although illness was mild , influenza accounted for a large proportion of unscheduled visits to a health care provider for respiratory illness and was associated with unnecessary antibiotic prescriptions that may contribute to antimicrobial resistance . Vaccination alone was insufficient to prevent infection . Thus , specific identification and management of influenza should be performed in HIV-infected out patients who present with fever and respiratory symptoms Background Since human immunodeficiency virus (HIV)-infected individuals are at increased risk of severe disease from p and emic influenza A ( H1N1pdm09 ) , vaccination was recommended as a prevention strategy . The aim of the present study was to evaluate the safety , immunogenicity and persistence of the immune response after vaccination against p and emic influenza A ( H1N1pdm09 ) with an adjuvanted vaccine in human immunodeficiency virus (HIV)-infected adults using two single and two double doses . Methodology /Principal Findings Open label , r and omized trial to evaluate the immune response following H1N1pdm09 vaccination in HIV-infected participants compared to HIV-negative controls ( NCT01155037 ) . HIV-infected participants were r and omized to receive 2 single ( 3.75 µg hemagglutinin ) or 2 double ( 7.5 µg hemagglutinin ) doses of the vaccine , 21 days apart . Controls received one dose of the vaccine . The primary endpoint was seroconversion as measured by hemagglutination inhibition assay . Two hundred fifty six HIV-infected participants ( 129 and 127 r and omized to single and double doses , respectively ) and 71 HIV-negative controls were enrolled . Among HIV-infected participants , seroconversion increased from 46.7 % and 51.7 % after the first dose to 77.2 % and 83.8 % after the second dose of the vaccine using single and double doses , respectively . Participants aged > 40 years showed higher seroconversion compared to younger participants . Seroconversion among HIV-infected women and those with nadir CD4<200 cells/mm3 was significantly higher with double doses . Persistence of protective antibodies six months after vaccination was achieved by 80 % and 89.9 % of the HIV-infected participants who received single and double doses , respectively . Conclusions / Significance Our results support the recommendation of two double doses of adjuvanted H1N1pdm09 vaccine for HIV-infected individuals , particularly women , and those aged > 40 years or with nadir CD4<200 cells/mm3 , to achieve antibody levels that are both higher and more sustained . Trial Registration Clinical Trials.gov Design Children with HIV are especially susceptible to complications from influenza infection , and effective vaccines are central to reducing disease burden in this population . We undertook a prospect i ve , observational study to investigate the safety and immunogenicity of the inactivated split-virion AS03-adjuvanted p and emic H1N1(2009 ) vaccine in children with HIV . Setting National referral centre for Paediatric HIV in Irel and . Sample Twenty four children with HIV were recruited consecutively and received two doses of the vaccine . The serological response was measured before each vaccine dose ( Day 0 and Day 28 ) and 2 months after the booster dose . Antibody titres were measured using a haemagglutination inhibition ( HAI ) assay . Seroprotection was defined as a HAI titre ≥ 1:40 ; seroconversion was defined as a ≥ fourfold increase in antibody titre and a postvaccination titre ≥ 1:40 . Main outcome measures The seroconversion rates after prime and booster doses were 75 % and 71 % , respectively . HIV virological suppression at the time of immunization was associated with a significantly increased seroconversion rate ( P = 0·009 ) , magnitude of serological response ( P = 0·02 ) and presence of seroprotective HAI titres ( P = 0·017 ) two months after the booster dose . No other factor was significantly associated with the seroconversion/seroprotection rate . No serious adverse effects were reported . Vaccination had no impact on HIV disease progression  . The AS03-adjuvanted p and emic H1N1 vaccine appears to be safe and immunogenic among HIV-infected children . A robust serological response appears to be optimized by adherence to a HAART regimen delivering virological suppression Antigenically well-matched vaccines against highly pathogenic avian influenza H5N1 viruses are urgently required . Human serum sample s after immunization with MF59 or nonadjuvanted A/duck/Singapore/97 ( H5N3 ) vaccine were tested for antibody to 1997 - 2004 human H5N1 viruses . Antibody responses to 3 doses of nonadjuvanted vaccine were poor and were higher after MF59-adjuvanted vaccine , with seroconversion rates to A/HongKong/156/97 , A/HongKong/213/03 , A/Thail and /16/04 , and A/Vietnam/1203/04 of 100 % ( P < .0001 ) , 100 % ( P < .0001 ) , 71 % ( P = .0004 ) , and 43 % ( P = .0128 ) in 14 subjects , respectively , compared with 27 % , 27 % , 0 % , and 0 % in 11 who received nonadjuvanted vaccine . These findings have implication s for the rational design of p and emic vaccines against influenza H5 Influenza vaccination is recommended for patients with HIV-1 infection ( 1 ) , but no studies have measured its efficacy in this population . Patients infected with HIV-1 , especially those with low CD4 + cell counts , often have minimal antibody responses to influenza vaccine ( 2 , 3 ) , leading some research ers to conclude that vaccination is not cost-effective ( 4 ) . In addition , vaccination has been associated with transient increases in HIV replication ( 5 - 8 ) and small decreases in percentage of CD4 cells ( 8) ; both of these findings are of undetermined clinical relevance . To better estimate the potential benefit of routine influenza vaccination in persons infected with HIV , we conducted a r and omized , controlled trial of influenza vaccine in a sample of HIV-1-infected patients during one influenza season . Methods Study Design The study site , a hospital-based clinic affiliated with the U.S. military , provides care to 400 to 500 patients infected with HIV-1 . Posters invited patients who visited the clinic from October to December 1995 to refer themselves for enrollment . All HIV-infected patients who had not yet received their annual influenza vaccine were eligible to participate . All patients gave informed consent , and the hospital 's institutional review board approved the study . Blood was drawn for measurement of CD4 + cell counts , influenza antibody titers , and plasma quantitative HIV-1 RNA level . Using a r and om computer-generated sequence , which was kept sealed until the end of the study , pharmacy staff prepared syringes that were filled with saline or with influenza vaccine purchased by the hospital for clinical use ( whole virion containing 15 g each of A/Johannesburg/33/94 [ H3N2 ] , A/Texas/36/91 [ H1N1 ] , and B/Harbin/07/94 [ Pasteur Mrieux Connaught , Lyon , France ] . Clinic staff could not distinguish vaccine from placebo . At 1 and 3 months after vaccination , patients returned for follow-up measurement of CD4 + cell count and HIV-1 RNA level and for serologic examination for influenza . Patients returned for viral cultures only if respiratory symptoms developed . At the conclusion of the study , all patients were interviewed about respiratory illness ( broadly defined as any rhinitis , pharyngitis , or cough ) experienced during the study period . Laboratory Assays Sample s for T-cell subset analysis were processed according to st and ard methods . The variation of percentage of CD4 cells on replicate testing was 1 % . Plasma sample s for measurement of HIV-1 RNA level were drawn in acid citrate-dextrose tubes , separated at 2000 rpm for 15 minutes , and stored at 70 C. Serum sample s were stored similarly . Quantitative HIV RNA reverse transcriptase polymerase chain reaction assays ( Amplicor Monitor , Roche , Nutley , New Jersey ) were done in batches by Quest Diagnostics at Nichols Institute , San Juan Capistrano , California ; all specimens from individual patients were tested simultaneously . The lower limits of quantification were 400 RNA copies per mL of plasma , and the intra-assay coefficient of variation of 32.3 % to 45.3 % . Serum sample s taken before and 1 month after vaccination were tested for antibody responses to each of the three individual vaccine components by microtiter hemagglutination inhibition ; egg-grown virus antigens starting at a dilution of 1:4 were used ( 9 ) . Sample s below this threshold were assigned a value of  
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND To determine the rate of seroconversion after 2 doses of a novel split virion , inactivated , adjuvanted p and emic H1N1 influenza vaccine ( A/California/7/2009 ) in human immunodeficiency virus type 1 (HIV-1)-infected patients ( Clinical Trials.gov NCT01017172 ) . METHODS Diagnostic study of adult HIV-1-infected patients scheduled for H1N1 influenza A vaccination .  Blood sample s where taken before and 21 days after the first dose and 21 days after the second dose of the vaccine . Antibody ( AB ) titers were determined by hemagglutination inhibition assay . Seroconversion was defined by either an AB titer ≤ 1:10 before and ≥ 1:40 after or ≥ 1:10 before and a ≥ 4-fold increase in AB titer 21 days after vaccination . RESULTS One hundred thirty-five patients received 2 doses of the H1N1 vaccine and were analyzed . The rate of seroconversion was 68.2 % ( 95 % confidence interval , 59.6 - 75.9 ) after the first dose and 91.9 % ( 95 % confidence interval , 85.9 - 95.9 ) after the second dose . Patients who did not seroconvert had a lower mean nadir CD4 cell count ( ± st and ard deviation ; 81 ± 99 vs 190 ± 148 cells/μL ; P = .006 ) , had a longer duration of HIV infection ( ± st and ard deviation ; 13.1 ± 5.9 vs 8.8 ± 6.8 years ; P = .04 ) , and were more likely to have an AB titer ≥ 1:40 before vaccination ( 4 % vs 55 % ; P < .001 ) when compared with patients with seroconversion . No other differences were found between the 2 groups , including AIDS status , highly active antiretroviral therapy status , HIV RNA - polymerase chain reaction load < 50 copies/mL , CD4 cell count , sex , body mass index , and chronic hepatitis . CONCLUSION Among HIV-infected patients , the rate of seroconversion after the first dose of an adjuvanted H1N1 influenza A vaccine was 68 % and increased to 92 % after a second doses BACKGROUND There are , to our knowledge , no prospect i ve studies of respiratory tract infections in human immunodeficiency virus (HIV)-infected adults in the highly active antiretroviral therapy ( HAART ) era . We performed a surveillance study of out patients who presented with fever and respiratory symptoms to examine the role of viral pathogens in these patients . METHODS Consecutive patients with a temperature of > 38.0 degrees C and respiratory symptoms were recruited from a tertiary care HIV clinic during the period 2003 - 2006 . Nasal pharyngeal sample s were tested for influenzavirus A and B , respiratory syncytial virus , and human metapneumovirus using real-time multiplex polymerase chain reaction assays . Paired acute- and convalescent-phase serum sample s were tested for respiratory viruses by complement fixation . RESULTS Fifty patients ( 90 % of whom were receiving HAART ) were included in the study ( median CD4(+ ) T cell count , 325 cells/microL ; median HIV RNA level , < 50 copies/mL ) . A causative pathogen was identified in 25 patients ( 50 % ) . Even though 76 % of subjects had received influenza vaccine , viral infections were diagnosed in 21 patients ( 42 % ) , as follows : influenza A , 10 patients ; influenza B , 10 ; and parainfluenza virus type 3 infection , 1 . Patients with and those without viral infection had similar demographic characteristics and HIV statuses . No patients with influenza and 23 % of patients with other conditions had radiography-confirmed pneumonia ( P=.07 ) . Antibiotic prescriptions were common : 70 % of patients received antibiotics . No patients with influenza required hospitalization , compared with 21 % of other patients ( P=.03 ) . CONCLUSIONS Although illness was mild , influenza accounted for a large proportion of unscheduled visits to a health care provider for respiratory illness and was associated with unnecessary antibiotic prescriptions that may contribute to antimicrobial resistance . Vaccination alone was insufficient to prevent infection . Thus , specific identification and management of influenza should be performed in HIV-infected out patients who present with fever and respiratory symptoms Background Since human immunodeficiency virus (HIV)-infected individuals are at increased risk of severe disease from p and emic influenza A ( H1N1pdm09 ) , vaccination was recommended as a prevention strategy . The aim of the present study was to evaluate the safety , immunogenicity and persistence of the immune response after vaccination against p and emic influenza A ( H1N1pdm09 ) with an adjuvanted vaccine in human immunodeficiency virus (HIV)-infected adults using two single and two double doses . Methodology /Principal Findings Open label , r and omized trial to evaluate the immune response following H1N1pdm09 vaccination in HIV-infected participants compared to HIV-negative controls ( NCT01155037 ) . HIV-infected participants were r and omized to receive 2 single ( 3.75 µg hemagglutinin ) or 2 double ( 7.5 µg hemagglutinin ) doses of the vaccine , 21 days apart . Controls received one dose of the vaccine . The primary endpoint was seroconversion as measured by hemagglutination inhibition assay . Two hundred fifty six HIV-infected participants ( 129 and 127 r and omized to single and double doses , respectively ) and 71 HIV-negative controls were enrolled . Among HIV-infected participants , seroconversion increased from 46.7 % and 51.7 % after the first dose to 77.2 % and 83.8 % after the second dose of the vaccine using single and double doses , respectively . Participants aged > 40 years showed higher seroconversion compared to younger participants . Seroconversion among HIV-infected women and those with nadir CD4<200 cells/mm3 was significantly higher with double doses . Persistence of protective antibodies six months after vaccination was achieved by 80 % and 89.9 % of the HIV-infected participants who received single and double doses , respectively . Conclusions / Significance Our results support the recommendation of two double doses of adjuvanted H1N1pdm09 vaccine for HIV-infected individuals , particularly women , and those aged > 40 years or with nadir CD4<200 cells/mm3 , to achieve antibody levels that are both higher and more sustained . Trial Registration Clinical Trials.gov Design Children with HIV are especially susceptible to complications from influenza infection , and effective vaccines are central to reducing disease burden in this population . We undertook a prospect i ve , observational study to investigate the safety and immunogenicity of the inactivated split-virion AS03-adjuvanted p and emic H1N1(2009 ) vaccine in children with HIV . Setting National referral centre for Paediatric HIV in Irel and . Sample Twenty four children with HIV were recruited consecutively and received two doses of the vaccine . The serological response was measured before each vaccine dose ( Day 0 and Day 28 ) and 2 months after the booster dose . Antibody titres were measured using a haemagglutination inhibition ( HAI ) assay . Seroprotection was defined as a HAI titre ≥ 1:40 ; seroconversion was defined as a ≥ fourfold increase in antibody titre and a postvaccination titre ≥ 1:40 . Main outcome measures The seroconversion rates after prime and booster doses were 75 % and 71 % , respectively . HIV virological suppression at the time of immunization was associated with a significantly increased seroconversion rate ( P = 0·009 ) , magnitude of serological response ( P = 0·02 ) and presence of seroprotective HAI titres ( P = 0·017 ) two months after the booster dose . No other factor was significantly associated with the seroconversion/seroprotection rate . No serious adverse effects were reported . Vaccination had no impact on HIV disease progression  . The AS03-adjuvanted p and emic H1N1 vaccine appears to be safe and immunogenic among HIV-infected children . A robust serological response appears to be optimized by adherence to a HAART regimen delivering virological suppression Antigenically well-matched vaccines against highly pathogenic avian influenza H5N1 viruses are urgently required . Human serum sample s after immunization with MF59 or nonadjuvanted A/duck/Singapore/97 ( H5N3 ) vaccine were tested for antibody to 1997 - 2004 human H5N1 viruses . Antibody responses to 3 doses of nonadjuvanted vaccine were poor and were higher after MF59-adjuvanted vaccine , with seroconversion rates to A/HongKong/156/97 , A/HongKong/213/03 , A/Thail and /16/04 , and A/Vietnam/1203/04 of 100 % ( P < .0001 ) , 100 % ( P < .0001 ) , 71 % ( P = .0004 ) , and 43 % ( P = .0128 ) in 14 subjects , respectively , compared with 27 % , 27 % , 0 % , and 0 % in 11 who received nonadjuvanted vaccine . These findings have implication s for the rational design of p and emic vaccines against influenza H5 Influenza vaccination is recommended for patients with HIV-1 infection ( 1 ) , but no studies have measured its efficacy in this population . Patients infected with HIV-1 , especially those with low CD4 + cell counts , often have minimal antibody responses to influenza vaccine ( 2 , 3 ) , leading some research ers to conclude that vaccination is not cost-effective ( 4 ) . In addition , vaccination has been associated with transient increases in HIV replication ( 5 - 8 ) and small decreases in percentage of CD4 cells ( 8) ; both of these findings are of undetermined clinical relevance . To better estimate the potential benefit of routine influenza vaccination in persons infected with HIV , we conducted a r and omized , controlled trial of influenza vaccine in a sample of HIV-1-infected patients during one influenza season . Methods Study Design The study site , a hospital-based clinic affiliated with the U.S. military , provides care to 400 to 500 patients infected with HIV-1 . Posters invited patients who visited the clinic from October to December 1995 to refer themselves for enrollment . All HIV-infected patients who had not yet received their annual influenza vaccine were eligible to participate . All patients gave informed consent , and the hospital 's institutional review board approved the study . Blood was drawn for measurement of CD4 + cell counts , influenza antibody titers , and plasma quantitative HIV-1 RNA level . Using a r and om computer-generated sequence , which was kept sealed until the end of the study , pharmacy staff prepared syringes that were filled with saline or with influenza vaccine purchased by the hospital for clinical use ( whole virion containing 15 g each of A/Johannesburg/33/94 [ H3N2 ] , A/Texas/36/91 [ H1N1 ] , and B/Harbin/07/94 [ Pasteur Mrieux Connaught , Lyon , France ] . Clinic staff could not distinguish vaccine from placebo . At 1 and 3 months after vaccination , patients returned for follow-up measurement of CD4 + cell count and HIV-1 RNA level and for serologic examination for influenza . Patients returned for viral cultures only if respiratory symptoms developed . At the conclusion of the study , all patients were interviewed about respiratory illness ( broadly defined as any rhinitis , pharyngitis , or cough ) experienced during the study period . Laboratory Assays Sample s for T-cell subset analysis were processed according to st and ard methods . The variation of percentage of CD4 cells on replicate testing was 1 % . Plasma sample s for measurement of HIV-1 RNA level were drawn in acid citrate-dextrose tubes , separated at 2000 rpm for 15 minutes , and stored at 70 C. Serum sample s were stored similarly . Quantitative HIV RNA reverse transcriptase polymerase chain reaction assays ( Amplicor Monitor , Roche , Nutley , New Jersey ) were done in batches by Quest Diagnostics at Nichols Institute , San Juan Capistrano , California ; all specimens from individual patients were tested simultaneously . The lower limits of quantification were 400 RNA copies per mL of plasma , and the intra-assay coefficient of variation of 32.3 % to 45.3 % . Serum sample s taken before and 1 month after vaccination were tested for antibody responses to each of the three individual vaccine components by microtiter hemagglutination inhibition ; egg-grown virus antigens starting at a dilution of 1:4 were used ( 9 ) . Sample s below this threshold were assigned a value of  
    Output:
    