HIV: Immunisation

Key points

• The Department of Health 'Greenbook' on immunisation defers to the British HIV Association for guidelines relating to immunisation of HIV-infected adults Vaccines that can be used in all HIV-infected adults Vaccines that can be…
• ORIGINAL SOURCE MISSING — NEW EVIDENCE-BASED CONTENT CREATED. The vaccine lists referred to above were never captured and exist nowhere in this package. Written from current UK sources; NOT recovered source text. Note BHIVA stated in January 2024 that its immunisation guidelines were being updated — check for a newer version.
• THE GOVERNING RULE: LIVE ATTENUATED vaccines are CONTRAINDICATED where the CD4 count is BELOW 200 cells/µL (or under 15%) and/or there is AIDS. This covers MMR, varicella, yellow fever and ORAL live typhoid.
• At CD4 200 or above, live vaccines can generally be given: non-immune individuals should receive 2 doses of MMR at least 4 weeks apart, and non-immune individuals 2 doses of varicella vaccine.
• Where oral live typhoid is contraindicated (CD4 < 200), give the INACTIVATED parenteral polysaccharide typhoid vaccine instead · the combined MMRV vaccine should NOT be used in people with HIV.
• MEASLES EXPOSURE in a non-immune person: if CD4 is 200 or above, give MMR within 72 hours OR immunoglobulin within 6 days · if CD4 is below 200, or the person is pregnant, give IMMUNOGLOBULIN within 6 days — not the vaccine.
• INACTIVATED vaccines are safe at any CD4 count and are actively recommended: pneumococcal conjugate vaccine (regardless of CD4 count if not previously vaccinated), annual influenza, hepatitis A and B, HPV, and meningococcal vaccination.
• Vaccine RESPONSE is impaired when the viral load is unsuppressed or the CD4 count is low, so timing matters and post-vaccination serology may be checked for some vaccines · the mpox (modified vaccinia Ankara) vaccine is live but NON-REPLICATING and is considered safe in HIV, though effectiveness may be lower at CD4 below 200.