Is it possible to immunize AIDS patients. What vaccinations should a person living with HIV get? Can I get an HIV measles vaccine?
Vaccination and HIV
Many diseases can be avoided by getting vaccinated. In this regard, many people living with HIV are interested in the question of how vaccination affects the body, as well as which vaccines can be done, and which ones are better to refrain from. In this article, you can find answers to these questions.
What is vaccination?
Vaccination, or immunization, is a modern and effective means of preventing many diseases. In response to the administration of a vaccine containing weakened or killed microorganisms, the body's immune system produces antibodies to them. When pathogenic microbes subsequently enter the body, the body already has the skill of successfully combating them.
Most vaccines are designed to prevent infections. However, there are some that help the body fight infection that is already present in the body. They are called therapeutic vaccines.
Live vaccines contain an attenuated live microorganism. They are able to multiply in the body and cause an immune response, forming immunity to this disease. In this case, the disease can proceed in mild form, but then the immune system studies the vaccine and begins to produce special substances to destroy it.
Inactivated vaccines contain either the killed whole microorganism or components of the cell wall or other parts of the pathogen. That is, a person does not get sick, but the body develops immunity to this kind diseases.
Some side effects may occur with vaccination. With the introduction of a live vaccine, the disease can be mild. Even when an inactivated vaccine is given, your immune system reacts to it. As a result, reactions such as pain and redness at the injection site, weakness, fatigue or nausea can occur for about a day.
How is vaccination different for people with HIV?
Since HIV gradually destroys immune system, the vaccine may not work as well or the immune response may take longer. Also, vaccination in people with HIV can cause more side effects... Vaccines can even cause the disease they are supposed to protect against.
There are few studies on the effects of vaccination on people with HIV, especially since the advent of antiretroviral therapy. However, there are some basic guidelines for people with HIV that can be offered:
Vaccination can increase the viral load for a while. On the other hand, getting sick with the flu, hepatitis, or other preventable diseases is much worse. It is not recommended to get tested for viral load within 4 weeks after vaccination.
Influenza vaccination for people living with HIV is the best understood. It has been proven to be effective and safe. However, people with HIV are not advised to use the nasal vaccine as it contains live virus.
If you have a very low immune status, the vaccine may not work. If possible, strengthen the immune system by taking antiretroviral therapy prior to vaccination.
Many live vaccines, including smallpox vaccine, are not recommended for people with HIV. It is not recommended to be vaccinated against smallpox unless your healthcare provider agrees that it is safe for you. Try to avoid contact with people who have been vaccinated against smallpox for 2-3 weeks. Measles, mumps and rubella vaccines have been proven to be safe for people with HIV if the immune status is above 200 cells / ml.
1. From pneumonia
People living with HIV are at higher risk of developing pneumococcal pneumonia. An effective vaccine becomes in 2-3 weeks. The protective effect of the vaccine lasts for about 5 years.
2. From hepatitis
There are several types viral hepatitis... Vaccines are available for hepatitis A and B. Hepatitis A is not a serious threat, but it can be quite problematic for people with a weakened liver. The same goes for people with hepatitis B and C. Two hepatitis A shots can protect you for 20 years. 3 vaccinations against hepatitis B can provide protection against it for 10 years.
3. From flu
You must get a flu shot every year. Flu shots are recommended for all people living with HIV. For best protection, it is recommended that you get vaccinated sometime in November before the flu season. In some cases, the flu can develop into pneumonia. Some vaccines can cause allergic reaction in people who are allergic to eggs.
4. From tetanus and diphtheria
Tetanus - serious illnesswhich is caused by common bacteria. Tetanus infection can be spread through skin wounds. It is not transmitted from one person to another. People who inject drugs are at high risk of tetanus infection. Diphtheria is also bacterial infection... It can be passed from one person to another and is common in homeless people. The diphtheria vaccine is always given with the tetanus shot. Diphtheria and tetanus are usually vaccinated in childhood... It is not recommended for people with HIV to get vaccinated more than once every 10 years.
5. From measles, mumps and rubella
Measles, mumps and rubella - viral infections... They can be transmitted by airborne droplets. Usually one vaccination protects for a lifetime. However, since this live vaccine, it is not recommended for people with immune status below 200 cells / ml.
If you are going on a trip
Before traveling, you must make sure that you are vaccinated against hepatitis A and B. Each country has different requirements for vaccination upon entry. In general, inactivated vaccines should not be a problem for people with HIV traveling. However, live vaccines, including typhoid, yellow fever and vaccinia, should be avoided. If a polio vaccine is required, then it must be inactivated, but not alive. In this case, you need to get a letter from your doctor stating that, for medical reasons, you should not receive a live vaccine. This practice is accepted in most countries.
Do not be afraid you have not been infected with anything
IS IT POSSIBLE TO IMMUNIZE AIDS PATIENTS
V.V. Pokrovsky
Russian Scientific and Methodological Center for Prevention
and the fight against AIDS, Moscow
Following the identification of the first cases of acquired immune deficiency syndrome (AIDS), in which patients die from infections caused by opportunistic flora, which is of little danger to healthy people, it was quite natural to assume that the introduction of even "weakened" vaccine strains to AIDS patients can lead to serious consequences. In addition, it was noted that one of the features of immunity disorders in AIDS patients is a decrease in the immune response to new antigens, and vaccination of AIDS patients may not have any effect at all. The conclusion was that since vaccination is dangerous and useless, it is better not to carry it out at all.
The discovery of the human immunodeficiency virus (HIV), which causes AIDS, and a long-term study of the characteristics of the course of the disease led to a revision of views on this problem. It turned out that significant immunity disorders are characteristic of the late stage of the disease (5-10 years or more after HIV infection). The degree of immune deficiency is determined, first of all, by the number of cells carrying the CD4 receptor. As long as these cells are more than 500 mm. cub. (0.5 ml in the SI system) blood, the immune system functions fully. If the cell count is less than 500, but not less than 200, immunity is already reduced, relatively easily treatable opportunistic infections may appear, the response to new antigens is still quite possible, although it may be reduced. Decrease in the number of CD4 cells to less than 200 mm. cub. blood (less than 0.2 per ml) already undoubtedly poses a threat to life, since there is the possibility of developing fatal dangerous infections... But it is not influenza, measles or mumps and other diseases that vaccination is used to prevent for HIV-infected people, but, with rare exceptions (tuberculosis), just those for the prevention of which vaccines have not been developed. In addition, although complications after vaccination in HIV-infected people have been described, statistical analysis does not reveal an unconditional increase in the number of severe post-vaccination processes among HIV-infected people vaccinated (before the diagnosis of HIV infection), compared with the rest of the population. Therefore, most modern researchers admit the possibility of effective and safe vaccination HIV-infected persons killed vaccines. On the agenda is the question of vaccination with live vaccines. It is known that vaccination can be accompanied by a short-term decrease in the number of CD4 cells. With the beginning of the application in the clinic of a new method for determining the concentration of HIV RNA in the blood ("viral load"), the issue of vaccination has acquired a new perspective. Currently, this indicator is used to determine the effectiveness of treatment (successful therapy leads to its decrease). After vaccination, an increase in the concentration of HIV RNA is often noted, as well as after an illness. This can mislead doctors, especially since it is not yet known how these time fluctuations affect the prognosis of the disease.
On the other hand, in most countries of the world it is not possible to determine either the number of CD4 cells or, let alone the viral load. There is not even a way to diagnose HIV infection. In economically underdeveloped Africa, with a prevalence of HIV infection among pregnant women of 5-10%, it is unlikely that all children will be tested for HIV, and infected children are unlikely to be tested for CD4 cells, and even more so for "viral load". In Africa, for example, preventive vaccinations conduct for all children without exception for pragmatic reasons.
But in developed countries there are financial prerequisites for inoculating HIV-infected people. For example, in the case of an HIV-infected person with influenza, it is necessary to carry out a complex and expensive differential diagnosis between influenza and many febrile opportunistic infections.
IN general view, current recommendations boil down to the fact that HIV-infected can be vaccinated with inactivated vaccines, and it is permissible to be vaccinated using "live" vaccines. There are exceptions to this rule when it comes to vaccinations in outbreaks. In particular, BCG is sometimes recommended for children at high risk of tuberculosis infection. With regard to vaccination against measles, many experts believe that the chances of a child dying from measles are so high that it can be neglected. possible complications... However, some developed countries have so far refrained from finally solving this problem. However, in cases of travel to hotbeds of dangerous infections, such as yellow fever, vaccination with a live vaccine is in principle allowed, but taking into account the condition of the person being vaccinated.
In Russia, the issue of vaccination of children born to HIV-infected mothers has become a serious problem in last years, due to the increase in the number of infected women of childbearing age. Policy documents on HIV vaccination issues published in Russia are somewhat contradictory and differ from the publications of individual authors. The matter is further complicated by the fact that it is quite reliably possible to determine whether a child is infected with HIV or not by the age of 18 months, since maternal antibodies to HIV are present in all newborns from HIV-infected women. The use of methods for detecting HIV genetic material, in particular, using the polymerase chain reaction, does not always give an earlier result. Moreover, this method is not yet fully available. However, after establishing that the child is definitely not infected with HIV, he can be vaccinated according to an individual schedule, bringing him closer to the vaccination schedule.
If inactivated vaccines for HIV-infected people can be administered according to the vaccination schedule and according to indications, then the situation with live vaccines is more complicated. WHO is currently giving the following recommendations: BCG to children born to HIV-infected mothers, such vaccination is allowed for epidemic indications. For vaccination against poliomyelitis is used inactivated vaccine... Vaccination with live measles and mumps vaccines is recommended on a calendar, especially in cases where children are organized in groups and outbreaks of disease are possible. In addition to calendar vaccinations due to the increased incidence of HIV-infected pneumococcal infections, they are advised to vaccinate accordingly. For the same reason, it is recommended to vaccinate children against haemophilus influenzae. When vaccinating HIV-infected people should be guided by the regulatory documents approved by the Ministry of Health of the Russian Federation.
Recent data on the effectiveness of prevention of mother-to-child transmission of HIV, due to which the probability of having an infected child is reduced to 0-5 percent, allows us to hope that the problem of vaccination of children born to HIV-infected mothers, while maintaining a sufficiently large number (more than 500 in mm3) immune cells carrying the CD4 receptor will soon cease to be relevant.
There are no published data on interactions between the recommended influenza antiviral agents (oseltamivir, zanamivir and peramivir) and drugs used in the management of HIV-infected patients. Patients should be monitored for adverse reactions to influenza antiviral chemoprophylaxis agents, especially when neurological disorders or renal failure take place.
Should healthcare workers who come into contact with HIV / AIDS patients be vaccinated?
Influenza vaccination is recommended for all healthcare workers, including those directly involved in providing care to HIV-infected patients. More information on vaccination of health care workers can be found here: Preventing and Controlling Influenza Through Vaccination: Recommendations of the Committee of Advisers on Immunization Practices (ACIP), 2010.
Special notes on egg allergy
People with egg allergies can receive any licensed, recommended, age-appropriate influenza vaccine and no longer need to be monitored for 30 minutes after receiving the vaccine. People who are acutely allergic to eggs should be vaccinated in medical institution and be monitored by a healthcare professional who is able to recognize and manage acute allergic conditions.
WHAT ARE VACCINATIONS?
SPECIFIC VACCINATIONS FOR PEOPLE WITH HIV?
WHAT VACCINATIONS ARE RECOMMENDED?
HIV POSITIVE TRAVELERS
WHAT ARE VACCINATIONS?
Vaccinations or immunizations are treatments to build up the body's defenses against certain infections. For example, many people get flu shots every fall. The immune system's response to vaccination takes several weeks.
Most vaccinations are used to prevent infections. However, some of them help the body fight infections that the body already has. These are the so-called "therapeutic vaccines". See Fact Sheet 480 for more information on therapeutic vaccines and HIV.
Live vaccines use a weakened form of the microbe. They can cause mild illness, but after that, the immune system is ready to withstand more serious illness. Other "inactive" vaccines do not use live microbes. You cannot stand the disease, but the body can also create its own defenses.
Vaccinations can have side effects. In the case of "live" vaccines, a mild illness may appear. When using inactive vaccines, pain, redness, and swelling at the injection site may occur. You may feel weak, tired, or nauseous for a while.
WHAT ARE THE FEATURES OF VACCINATIONS FOR PEOPLE WITH HIV?
If HIV has damaged the immune system, it may not respond as well to the vaccine or respond over a different period of time. In addition, vaccines can cause more side effects in people with HIV. They can even cause the disease they are intended to prevent.
There hasn't been much research into vaccinating HIV-positive people, especially since the time people started taking combinations of antiretroviral drugs (ARVs). However, there are key recommendations for people with HIV:
- Vaccinations can increase your viral load (see fact sheet 125) for some time. On the other hand, getting the flu, hepatitis, or other preventable disease can have more negative consequences. Do not measure your viral load within 4 weeks of any vaccination.
- Flu shots have been studied more than any other vaccine for people with HIV. They are considered safe and effective. However, people with HIV should not use the FluMist nasal aerosol vaccine as it contains live virus.
- If your CD4 counts (see Fact Sheet 124) are very low, the vaccines may not work. If possible, strengthen your immune system by taking strong antiretroviral drugs before vaccination.
- HIV-positive people should not be vaccinated with most live vaccines (see below), including the chickenpox or smallpox. Do not get these vaccines unless your doctor has confirmed it will be safe. Avoid contact with anyone who has received a “live” vaccine in the past 2 or 3 weeks. However, measles, mumps and rubella vaccines are considered safe if your CD4 count is above 200.
1. Pneumonia:
Having HIV significantly increases your risk of developing pneumococcal pneumonia. The vaccine takes 2 or 3 weeks to be effective. For people with HIV, protection lasts about 5 years.
Partially funded by the National Library of Medicine
Can people living with HIV be vaccinated?
Vaccination, or immunization, is a modern and effective means of preventing many diseases. In response to the introduction of a vaccine containing weakened or "killed" microorganisms, the body's immune system produces antibodies to them. When pathogenic microbes subsequently enter the body, the body already has the skill of successfully combating them.
Most vaccines are designed to prevent infections. However, there are those that help the body fight an infection that has already entered the body. They are called "therapeutic" vaccines, in contrast to the "prophylactic" described above.
Live vaccines contain an attenuated live microorganism. They are able to multiply in the body and cause an immune response, forming immunity to this disease. At the same time, the disease can be mild, but then the immune system studies the vaccine and begins to produce special substances to destroy it.
"Inactivated" vaccines contain either the killed whole microorganism or components of the cell wall or other parts of the pathogen. That is, a person does not get sick, but the body develops immunity to this type of disease.
Because HIV gradually destroys the immune system, the vaccine may not work as well or the immune response may take longer. Also, vaccination in people with HIV can cause more side effects. Vaccines can even cause the disease they are supposed to protect against.
Vaccination can increase the viral load for a while. On the other hand, getting sick with the flu, hepatitis, or other preventable diseases is much worse. It is not recommended to get tested for viral load within 4 weeks after vaccination.
Influenza vaccination for people living with HIV is the best understood. It has been proven to be effective and safe. However, people with HIV are not advised to use a "nasal" vaccine, as it contains a "live" virus.
If you have a very low immune status, the vaccine may not work. If possible, strengthen the immune system by taking antiretroviral therapy prior to vaccination.
Try to avoid contact with people who have been vaccinated against these diseases for 2-3 weeks.