Research Article: Adverse events after vaccination among HIV-positive persons, 1990–2016

Date Published: June 19, 2018

Publisher: Public Library of Science

Author(s): John R. Su, Carmen Ng, Paige W. Lewis, Maria V. Cano, Nigel William Crawford.

http://doi.org/10.1371/journal.pone.0199229

Abstract

Human immunodeficiency virus (HIV) causes immune dysregulation, potentially affecting response to vaccines in infected persons. We investigated if unexpected adverse events (AEs) or unusual patterns of AEs after vaccination were reported among HIV-positive persons. We searched for domestic reports among HIV-positive persons to the Vaccine Adverse Event Reporting System (VAERS) during 1990–2016. We analyzed reports by age group (<19 and ≥19 years), sex, serious or non-serious status, live vaccine type (live versus inactivated), AEs reported, and CD4 counts. Of 532,235 reports received, 353 (0.07%) described HIV-positive persons, of whom 67% were aged ≥19 years, and 57% were male; most reports (75%) were non-serious. The most commonly reported inactivated vaccines were pneumococcal polysaccharide (27%) and inactivated influenza (27%); the mostly reported common live virus vaccines were combination measles, mumps, and rubella (8%) and varicella (6%). Injection site reactions were commonly reported (39%). Of 67 reports with CD4 counts available, 41 (61%) described persons immunocompromised at time of vaccination (CD4 count <500 cells/mm3), and differed from overall reports only in that varicella was the most common live virus vaccine (4 reports). Of 22 reports describing failure to protect against infection, 6 described persons immunocompromised at time of vaccination, among whom varicella vaccine was most common (3 reports). Of 66 reports describing live virus vaccines, 7 described persons with disseminated infection: 6 had disseminated varicella, 3 of whom had vaccine strain varicella-zoster virus. Of 18 reported deaths, 7 resulted from disseminated infection: 6 were among immunocompromised persons, 1 of whom had vaccine strain varicella-zoster virus. We identified no unexpected or unusual patterns of AEs among HIV-positive persons. These data reinforce current vaccine recommendations for this risk group. However, healthcare providers should know their HIV-positive patients’ immune status because immunocompromising conditions can potentially increase the risk of rare, but severe, AEs following vaccination with live virus vaccines.

Partial Text

Infection with Human immunodeficiency virus (HIV) remains a major public health concern: as of 2015, rates of new HIV diagnoses in the United States were 24.4 per 100,000 adolescent and adult men and 5.4 per 100,000 adolescent and adult women, [1] and the U.S. Centers for Disease Control and Prevention considers HIV infection a key Winnable Battle. [2] HIV infects CD4+ helper T-lymphocytes, depleting these cells and ultimately leading to acquired immunodeficiency syndrome (AIDS). Infection with HIV can lead to opportunistic infections, [3] and can also increase the risk of vaccine-preventable conditions like invasive pneumococcal infections and influenza-related complications. [4–6] For these reasons, recommendations for antibiotic prophylaxis and vaccines for HIV-positive persons exist. [7–10]

During January 1, 1990 through December 31, 2016, VAERS received 532,235 reports. Of these reports, we identified 353 (0.07%) describing persons who were HIV-positive (Table 1); medical records were available for 48 reports (14%). Most (266, 75%) reports were non-serious. Among reports that included age, most (86%) were among persons aged ≥19 years. Among reports with data on sex available, most (68%) were males. The most common vaccine types in the reports were inactivated influenza (IIV) (96, 27%) and pneumococcal polysaccharide (PPSV23) (94, 27%). Combined measles, mumps, and rubella (MMR) was the most common live virus vaccine (27, 8%). The most common AEs were injection site reactions (138, 39%), pain (92, 26%), and fever (63, 18%).

Our review of AEs reported to VAERS among HIV-positive persons revealed no unexpected AEs or unusual patterns of AEs: reported AEs were consistent with known health consequences of HIV infection and immunocompromised immune status, including one death involving disseminated varicella in a severely immunocompromised patient who had vaccine-strain VZV. Severe immunodeficiency is a contraindication to vaccination with live virus vaccines. [7] Our findings reinforce current general recommendations that for HIV-positive persons, inactivated vaccines are indicated, and live attenuated vaccines can be considered if severe immunodeficiency (e.g., CD4 <200 cells/mm3 among persons aged 6 years and older [23, 24]) and physical signs of such immunodeficiency are absent; [7, 8] providers might consider obtaining CD4 counts prior to administering live virus vaccines for patients known to be HIV-positive. If a patient is at risk for HIV infection (e.g., HIV-positive birth mother, known risk population), the provider might consider screening for HIV [25] prior to administering live virus vaccines.   Source: http://doi.org/10.1371/journal.pone.0199229

 

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