Vaccination
- Vaccinate according to national guidelines for healthy population, preferably after having achieved suppressed viraemia and immune reconstitution (CD4 count > 200 cells/μL)
- Consider repeating vaccinations performed at CD4 count < 200 cells/μL (< 14%) or unsuppressed viraemia once adequate immune reconstitution is achieved (HIV-VL undetectable and CD4 count > 200 cells/μL)
- As vaccine responses may be significantly lower in PLWH (i.e. lower seroconversion rates, faster titer decline), do not use rapid schedules (e.g. rabies, tick-borne encephalitis, HAV/HBV) and consider antibody titres to assess their effectiveness if vaccinated at CD4 count < 200 cells/μL or unsuppressed viremia (e.g. rabies, tick-borne encephalitis, HAV, meningococci). Be attentive to observe boosters and all post-exposure measures (particularly after potential rabies exposure)
- Avoid polysaccharide vaccination
- For background data, see http://www.bhiva.org/vaccination-guidelines.aspx
- For attenuated live vaccines(i) (in addition to restrictions for general population):
- *Varicella, measles, mumps, rubella, yellow fever
- Contraindicated if CD4 count < 200 cells/μL (14%) and/or AIDS. Impaired protection after vaccination with unsuppressed viraemia. Administer immunoglobulins if exposed and not yet vaccinated
- Oral live typhoid
- Preferred if CD4 count > 200 cells/μL (> 14%). Contraindicated if CD4 count < 200 cells/μL (14%): then give inactivated parenteral polysaccharide vaccine
- *Varicella, measles, mumps, rubella, yellow fever
Infection | Vaccination rationale in PLWH | Comment |
---|---|---|
Influenza Virus | Higher rate of pneumonia. Explicitly recommended in all PLWH | Yearly, use 4-valent vaccine if available |
Human Papilloma Virus (HPV) | Shared risk with HIV of contracting infection. Higher rate of cervical and anal cancer |
Vaccinate all PLWH with 3 doses between ages 9 and 45 (health insurance coverage differs by country according to age, sex, sexual orientation). Use 9-valent vaccine if available. Persons treated for high grade dysplasia could benefit from a full course vaccination for secondary prevention |
Hepatitis B Virus (HBV) | Shared risk with HIV of contracting infection. Untreated HIV accelerates progression of liver disease |
Vaccinate if seronegative. Repeat doses until anti-HBs antibodies ≥ 10 IU/L / ≥ 100 IU/L according to national Guidelines. In order to reach ≥ 100 IU/L in non-responders repeat 3 doses if anti-HBs < 10 IU/L, 1 dose if anti-HBs < 100 IU;(ii) consider double dose (40 μg) in particular with low CD4 count and high HIV-VL. No benefit for intradermal application. See Clinical Management and Treatment of Viral Hepatitis Co-infections in PLWH |
Hepatitis A Virus (HAV) | According to risk profile (travel, close contact with children, MSM, IVDU, active hepatitis B or C infection, chronic liver disease) |
Vaccinate if seronegative. Consider checking antibody titres in PLWH with high risk. Weaker immune response expected with HAV/HBV co-vaccine. See Clinical Management and Treatment of Viral Hepatitis Co-infections in PLWH |
Neisseria meningitidis | According to risk profile (travel, close contact with children, MSM) |
Use conjugated(iii) 4-valent vaccine (for serotypes A, C, W-135, Y; 2 doses 1-2 months apart) if available. Booster every five years if exposure continues. Polysaccharide vaccine no longer recommended. Vaccination against Meningococcus serotype B according to national Guidelines |
Streptococcus pneumoniae | Higher rate and severity of invasive disease. Vaccine explicitly recommended for all PLWH |
One dose of conjugated(iii) 13-valent vaccine (PCV-13) for all PLWH, also if pre-vaccinated with PPV-23 polysaccharide vaccine. No general recommendation for any booster dose. Some national guidelines consider one dose of PPV-23 at least 2 months after PCV-13 for all PLWH |
Varicella Zoster Virus (VZV) | Higher rate and severity of both chickenpox and zoster |
Perform serology if exposure history negative. Vaccinate if seronegative. For contraindications, see*. To prevent shingles, preferably use adjuvant recombinant sub-unit vaccine over live-attenuated vaccine according to national guidelines |
Yellow Fever Virus | Mandatory for travel to selected countries (provide exemption letter if no true risk of exposure) |
Contraindicated if past or current haematological neoplasia or thymus affection (thymoma, resection/radiation) For other contraindications, see*. Booster q 10 years |
Rabies |
For PLWH with CD4 count < 200 cells/μL or unsuppressed viremia consid- er pre-exposure vaccination with 3 doses (0, 7, 28 days) and titre control 14 days later. In case of exposure: full post-exposure prophylaxis including rabies immunoglobulins (RIG). If pre-exposure rabies vaccination administered when CD4 > 200 cells/μL: Post-exposure prophylaxis as for immunocompetent (one dose day 0 and day 3, without RIG) |
|
Severe Acute Respiratory Syndrome 2 (SARS-CoV-2) |
A higher prevalence of poor socio-economic circumstances and specific co-morbidities in PLWH (e.g. obesity, hypertension, CVD, DM) may increase the risk of acquiring SARS-CoV-2 infection and/or progressing to severe COVID-19 compared to the general population |
In a pandemic situation, vaccinate irrespective of CD4 count and HIV-VL according to national Guidelines |
- Administer live vaccines simultaneously or with an interval of 4 weeks
- In case of non-response, ART should contain TDF or TAF
- Conjugated vaccines are more immunogenic, induce memory cells, respond to boosting and reduce mucosal colonisation