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Immunizations in HIV-infected patients

INTRODUCTION

HIV infection, because of the immunocompromised state, is a risk factor for morbidity and mortality caused by a number of infections that can usually be prevented by immunization. A number of factors contribute to the HIV-infected patient's "net state of immunosuppression" including defects in cell-mediated immunity, B cell dysfunction, and suboptimal humoral immune responses [1]. In the absence of effective therapy, the immunocompromise is continually progressive. On the other hand, patients who respond to antiretroviral therapy (ART) have substantial increases in their CD4 cells, suggesting improved immunity.

Although vaccine efficacy is usually compromised in advanced disease, adequate responses can be achieved when vaccines are administered early after HIV infection [2]. Concerns have been raised about vaccine safety, specifically the risk of activating the immune system and the potential for increasing HIV replication and promoting HIV infection. As discussed below, the benefits of administering vaccines appear to outweigh the risks.

Prevention of opportunistic infections is discussed in detail elsewhere. (See "Primary prevention of opportunistic infections in HIV-infected patients".)

Treatment of these infections in general and in HIV-infected individuals is discussed in the dedicated topic reviews for each infection.

GUIDELINES

In 2013, the Infectious Diseases Society of America (IDSA) published guidelines for vaccination of immunocompromised hosts, including HIV-infected patients, as well as guidelines for the primary care of HIV infected individuals, which discussed vaccinations [3,4]. Recommendations on immunization in HIV-infected patients have also been discussed in the guidelines on prevention of opportunistic infections in adults and adolescents from the United States Centers for Disease Control and Prevention (CDC), the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America [5] and in the guidelines on prevention of opportunistic infections in children from the United States Department of Health and Human Services [6]. The vaccine recommendations in the last two guidelines reflect the HIV-specific discussion in the general recommendations on immunization from the Advisory Committee on Immunization Practices (ACIP) in the United States.

                                      

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Literature review current through: Mar 2014. | This topic last updated: Apr 1, 2014.
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