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B ritish HIV A ssociation Guidelines on the Use of Vaccines in HIV ‐Positive Adults 2015
Author(s) -
Geretti Anna Maria,
Brook Gary,
Cameron Claire,
Chadwick David,
French Neil,
Heyderman Robert,
Ho Antonia,
Hunter Michael,
Ladhani Shamez,
Lawton Mark,
MacMahon Eithne,
McSorley John,
Pozniak Anton,
Rodger Alison
Publication year - 2016
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/hiv.12424
Subject(s) - medicine , vaccination , immunology , immunogenicity , hepatitis b , population , hiv vaccine , shingles , immune system , intensive care medicine , environmental health , vaccine trial , virus
These guidelines provide updated, GRADE-based recommendations on the use of vaccines in HIVpositiveadults. Several factors have made the updating of HIV-specific vaccination guidelines important: effective antiretroviral therapy (ART) has substantially modified the natural history of HIV infection, vaccination practices are evolving, and a large number of novel vaccines are becoming available in clinical care. The update contains important new guidance regarding the use of new vaccines against human papillomavirus (HPV), shingles (herpes zoster), and pneumococcus. Further key updates are related to the use of hepatitis B, meningococcus, and pertussis vaccines.Compared with HIV-negative individuals, HIV-positive adults often have an increased risk of infection or experience more severe morbidity following exposure to vaccine-preventable diseases, and therefore a lower threshold for extending indications and offering vaccination may be appropriate relative to the general population. Improved health and prognosis mean that HIV-positive adults arealso increasingly likely to engage in travel or occupations that carry a risk of exposure to infectious agents, and these otherwise healthy individuals should not be denied protection or engagement with such activities if evidence indicates vaccination is safe and immunogenic. Immune responses to vaccination are often sub-optimal in HIV-positive patients, and while these improve with ART, they often remain lower and decline more rapidly than in HIV-negative individuals. However, many of these vaccines still afford protection and for some vaccines it is possible to improve immunogenicity by offering modified vaccine schedules, with higher or more frequent doses, without compromising safety. Non-replicating vaccines (e.g., whole inactivated, polysaccharide, conjugated, and subunit vaccines, or virus-like particles) can be used safely in HIV-positive persons, whereas replicating (live) vaccines have traditionally been contraindicated. However, ART-induced Immunorestoration reduces the risk of adverse events, in many cases shifting the risk-benefit ratio in favour of vaccination, whereby the risk of disease with natural infection becomes greater than the risk of live vaccine-related adverse events. Important examples of replicating vaccines that can be used in HIV-positive persons with good immunity include those for measles, mumps and rubella (MMR), varicella-zoster virus (VZV), and yellow fever. For vaccinated individuals, the importance of infection avoidance and infection controlshould continue to be emphasised.It is envisaged that the HIV specialist should provide overall guidance on vaccine use and enlist the help of primary care physicians for vaccine administration. Education of health care providers and good communication are key requirements to ensure successful implementation of this guidance. Despite evidence that HIV-positive persons benefit from vaccination, there are persisting perceptions about disease incidence and burden, and vaccine effectiveness and safety, which affect vaccination practices among health professionals caring for HIV-positive patients. It is hoped that this guidance will help overcoming such barriers.