Vaccination of HIV-infected Adults

LBS Gelinck; FP Kroon

Disclosures

HIV Ther. 2009;3(6):565 

In This Article

Abstract and Introduction

Abstract

Vaccination has been shown to be one of the most powerful tools to decrease morbidity and mortality caused by an array of infectious diseases. The risk and complications of some vaccine-preventable diseases is higher in HIV-infected individuals, underscoring the importance of vaccination in these patients. However, the immune response upon vaccination is generally impaired and shorter lasting in HIV-infected individuals, especially in those with low CD4+ T-lymphocyte counts and detectable HIV RNA, as compared with healthy controls. Even in patients responding to antiretroviral treatment, an impaired immune response may persist despite normalization of the CD4+-cell count. Caution with live-attenuated vaccines is warranted in HIV-infected individuals with low CD4 T-lymphocyte counts. Decisions regarding administering a live-attenuated vaccine should be made after weighing the risks and benefits on an individual basis. In this article the immunology of vaccination in HIV-infected individuals, as well as the most relevant caveats of vaccination in this patient group, are reviewed in addition to the currently available information concerning the influenza A/H1N1 2009 monovalent vaccine.

Introduction

Preventing or mitigating disease by vaccination is one of the most (cost-)effective interventions in medicine.[1] Routine vaccination programs for adults, which typically include booster vaccinations every decade against diphtheria, tetanus, pertusis and polio, also apply to HIV-infected adults.[2] In addition, influenza, pneumococcal, hepatitis A virus and HBV vaccines are indicated in (most) HIV-infected adults.[3–5] However, the effectiveness and safety of vaccines that prevent travel-associated infections might be lower in HIV-infected individuals as compared with healthy individuals.[6]

Numerous clinical and immunological factors have been correlated with an impaired immune response upon vaccination; most notably a low CD4 T-cell count and detectable HIV RNA at the time of vaccination.[7–13] Most clinical and immunological vaccination studies in HIV-infected individuals, including our own studies, are relatively small in sample size and rely on surrogate parameters, such as antibody titers, as the primary outcome.

This article summarizes the general principles of vaccination of HIV-infected adults, with the currently registered vaccines (thus excluding HIV vaccines and other vaccines in development) and refers to relevant practical guidelines.

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