GUIDELINES FOR IMMUNIZATIONS IN HIV-INFECTED PATIENTS

Abstract

Patients infected with the human immunodeficiency virus HIV are at high risk for infectious complications. Opportunistic pathogens cause significant morbidity and mortality in HIV-infected patients, and medications used for prophylaxis have gained wide acceptance. In addition, more common viral and bacterial pathogens cause significant morbidity and mortality in this patient population. Immunizations against common pathogens have historically been successful in controlling and potentially eradicating infectious agents. There are several features of HIV-infected patients; however, that have brought controversy to the subject of immunizations, and therefore regular immunization schedules for these patients have not gained wide acceptance. Features to consider for each immunization include the risk of acquiring the pathogen, the efficacy and side effects of the vaccine, and the potential for HIV viral activation from vaccination. Ignoring the potential consequences of HIV viral activation, immunizations that are considered otherwise safe to administer include inactivated vaccines, such as pneumococcal vaccine and influenza vaccine, and immunoglobulin preparations. In general, live vaccines are contraindicated in HIV-infected patients, with the exception of measles, mumps, and rubella (MMR). Because data pertaining to the quantitative effect of immunization on viral activation have only recently been available, first this research is summarized, followed by a discussion of the use of specific protective immunizations in persons with HIV infection. Table 1 summarizes available data on comparative efficacy, evidence for viral activation, and current public health service recommendations.