Pediatric vaccines in HIV-infected children.
OBJECTIVE
Current pediatric immunization recommendations in HIV infection are reviewed.


RESULTS
Following initiation of highly active antiretroviral therapy and restoration of immune responsiveness, consideration should be given to repeat boosting of childhood vaccines. Human papillomavirus vaccine is recommended for young girls since this virus is associated with an increased risk of anogenital cancers in HIV infection. HIV-infected infants immunized at birth with bacillus Calmette-Guerin who later developed AIDS were at increased risk of disseminated bacillus Calmette-Guerin infection so it is no longer recommended for known HIV-infected infants.


CONCLUSIONS
Despite suboptimal immune responses, routine inactivated immunizations are recommended. Live attenuated vaccines are generally not recommended with the exception of measles, mumps, rubella vaccine and varicella vaccines which can still be given to children who are not severely immunocompromised (CD4 lymphocytes >15%). Additional data are pending on rotavirus and human papillomavirus vaccine in HIV. A theoretical concern is enhanced HIV virus replication due to immune activation following immunization, but this is predicted to be greater following infection so the consensus has been to immunize. HIV viral replication may be enhanced transiently without increased progression of HIV disease.
Bill & Melinda Gates Foundation, Seattle, Washington, USA.
Jan M
JM
Agosti