Immunization in patients with HIV infection: are practical recommendations possible?
The purpose of this article is to review immunization recommendations for HIV-infected individuals in resource-constrained countries, particularly in sub-Saharan Africa. Recent evidence suggests that HIV-infected children are at risk for low immunization coverage in sub-Saharan Africa. Routine immunization is recommended for these children. In comparison with immunocompetent children, recommendations for live-attenuated vaccines differ in HIV-infected children. However, limited laboratory capacity to diagnose HIV infection amongst young children prevents the implementation of these HIV-specific guidelines in resource-constrained countries. Re-immunization has been the focus of recent research in high- and middle-income countries. Findings show that children established on highly active antiretroviral therapy have suboptimal vaccine-specific immunity and may benefit from re-immunization. Before re-immunization guidelines can be formulated for resource-constrained countries, several questions should be addressed, including whether all HIV-infected children will benefit from routine re-immunization and what optimal number of vaccine doses should be administered. Pneumococcal and influenza infections are important causes of morbidity and mortality amongst HIV-infected individuals. There is compelling evidence showing that pneumococcal conjugate vaccines will protect HIV-infected and uninfected children against invasive infection. Pneumococcal conjugate vaccines should be prioritized for introduction in countries with high HIV prevalence. Although, annual influenza immunization is recommended for HIV-infected individuals, the effectiveness in Africa remains unclear. In conclusion, this brief overview has identified several limitations of current immunization policy and practice for HIV-infected individuals living in resource-constrained countries.
Eley
Brian
B
Paediatric Infectious Diseases Unit, Red Cross Children's Hospital, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa. Brian.Eley@uct.ac.za
D017954:Africa South of the Sahara; D023241:Antiretroviral Therapy, Highly Active; D001424:Bacterial Infections / Q000517:prevention & control; D001428:Bacterial Vaccines / Q000008:administration & dosage / Q000276:immunology; D002648:Child; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D032541:Mass Vaccination; D017410:Practice Guidelines as Topic; D014765:Viral Vaccines / Q000008:administration & dosage / Q000276:immunology; D014777:Virus Diseases / Q000517:prevention & control
D001428:Bacterial Vaccines; D014765:Viral Vaccines