HIV Vaccination guidelines Flashcards
Which vaccines are live, and are absolutely contra-indicated in patients with HIV?
Influenza live attenuated nasal
TB - BCG
Typhoid live attenuated
Smallpox - live attenuated Vaccinia virus
Which live vaccines are contra-indicated, but can be given when CD4 count >200?
MMR
VZV chickenpox
VZV Shingles
Yellow fever
CD4 count must be >200
Preferably wait longer to vaccinate, but can be given as long as CD4 is not below 200
Replicating vaccines have risk of causing disease
Which vaccines are safe in HIV, regardless of CD4 count?
Hepatitis B subunit
Infelunza inactivated
HPV - VLP
Hepatitis A - inactivated
Polio - inactivated
Rabies - cell-culture derived
TBE - inactivated
JEV - cell derived inactivated
Patient with HIV is given a live vaccine safely
Can they be given another live vaccine the following week?
Recommend waiting at least 4 weeks between vaccines, as there are uncertainties over safety and immunogenicity/ efficacy
Patient with HIV and anti-HBc positive
HBV DNA negative
What action would you take with HBV vaccine?
Due to HIV, patient is considered immunosuppressed, so at risk of reactivation as lost memory
Initially - 1x HBV vaccine dose. Then check anti-HBs 1 month later
If the titer is >100 mIU/mL, no further vaccination is needed
if the titer is <100 mIU/mL, give 3x further HBV vaccine doses at months 0, 1, 6, Then check anti-HBs after this
Although vaccine response is better in people with CD4 >350 cells/mm3, vaccination should not be deferred in people with a lower CD4 count because some people with CD4 <350 cells/mm3 do respond to vaccination (AII).
Normal immunocompetent vaccine dates - 0, 1 month, 6 months
Immunocompetent anti-HBc positive would be considered immune for life, as had previous infection
Patient with HIV and anti-HBc positive
HBV DNA negative
Given 3x HBV vaccines.
Anti-HBs 1 month later is <10iu/ml
What action would you take?
Vaccine non-responder
Give another 3x HBV vaccines, with monthly interval
Fendrix may be preferred vaccine option
Patient with HIV and anti-HBc positive
HBV DNA negative
Given 3x HBV vaccines.
Anti-HBs 1 month later is 40iu/ml
What action would you take?
Partial responder
Give 1x further HBV vaccine, and then repeat anti-HBs 1 month later
Fendrix may be preferred vaccine option
Patient with HIV and anti-HBc positive
HBV DNA negative
Given 3x HBV vaccines.
Anti-HBs 1 month later is <10iu/ml
Given 3x HBV vaccines
Anti-HBs 1 month later is <10iu/ml
What action would you take?
Non-responder
If this is due to low CD4 count (<350), consider repeating the course when CD4 count improves
Otherwise check annual HBsAg if there is ongoing risk factors for acquisition
HIV patient
HBV screen immunity is negative
Considering primary immunisation
What immunisation schedule would you recommend?
Anti-HBs not detected
Primary vaccination - 4x vaccine doses at 0,1,2,6 months
Anti-HBs - <10 - revaccinate 3x doses
Anti-HBs - 10-100 - booster dose 1x
Anti-HBs - >100 - immune. If CD4 >350, then immune. If CD4 <350, check anti-HBs annually
What are common brands of HBV vaccines?
Engirex - most common
Fendrix - usually used if person is a vaccine non-responder
Twinrix - combined HBV/HAV vaccine. May be used for initial vaccination, but not recommended in non-responders who are repeating their immunisations
HAV immunisation
Which HIV patient groups would be recommended to be immunised?
Travellers
MSM
IVDU
Occupational
Most HIV patients will qualify for immunisation
HAV immunisation
What vaccines are available?
Inactivated HAV vaccine
HAV/HBV vaccine
