|
pneumococcal vaccination are data showing it reduces the high rates of pneumococcal bacteremia in patients with HIV infection (Vaccine 2004;22:2006; Arch Intern Med 2005;165:1533). One case-control study found that the major factors in reducing risk were antiretroviral therapy (OR-0.23) and pneumococcal vaccination (OR 0.44) (CID 2007;45:e82).
Hemophilus influenzae:The risk to adults with HIV infection is low for H. influenzae type B. Most infections are due to non-type B strains that are not covered by the vaccine. The Hib vaccine is not recommended.
Hepatitis A vaccine
INDICATION:1) Chronic liver disease, travelers to countries where HAV is endemic or epidemic, IDU or MSM plus 2) neg serology for HAV (optional test) plus 3) CD4 >200 cells/mm3.
RISK: 1) MSM, 2) drug users (injection and non-injection), and 3) persons with chronic liver disease, including chronic HBV and HCV (MMWR 2002;51[RR-6]:61). Susceptibility is defined by negative total HAV antibody, which is present 30% of American adults. Some authorities recommend HAV vaccination for all non-immune patients as defined by negative (total anti-HAV antibody).
PREFERRED : HAV vaccine 0.5 mL IM x 2 separated by 6 months.
Hepatitis B vaccine
INDICATION : CD4 count >350 cells/mm3 and negative anti-HBs screening test.
Note:Most patients with isolated anti-HBc are not immune and should be vaccinated (JAIDS 2003;34:439).
PREFERRED : Response rates to standard HBV vaccine in patients with HSV are only 40-60% compared to >90% in other populations (Ann Intern Med 1988;109:101; AIDS 1992;6:509; AIDS Resp Ther 2006;3:9). The 2008 NIH/CDC/IDSA Guidelines on the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and a Adolescents recommend the standard 3 dose series but some note a possibly better response with double dose or 40 mcg doses IM at 0, 1 and 6 months (Vaccine 2000;18: 1161;Vaccine 2005;23:2902; J Clin Gastro 1992;14:27). One report noted a response rate of 51% in patients given the double dose after failure to response to the standard dose series (JID 2008;197:292). With a low CD4 count, delay vaccination until immune reconstitution.
Note:Repeat anti-HBs at 1 month after the 3rd dose (Ann Intern Med 1988;109:101). If anti-HBs is <10 IU/mL consider repeating the series or the double dose regimen.
|
