2015 BHIVA GUIDELINES on the use of vaccines in HIV-positive Adults

December 3, 2016 at 9:28 am

Writing Group

Chair and Editor: Prof Anna Maria Geretti

Members (in alphabetic order):

Dr Gary Brook, Central Middlesex Hospital, London

Ms Claire Cameron, Public Health England, London

Dr David Chadwick, James Cook University Hospital, Middlesbrough

Prof Neil French, University of Liverpool

Prof Robert Heyderman, University College London

Dr Antonia Ho, University of Liverpool

Dr Michael Hunter, Belfast Health and Social Care Trust

Dr Shamez Ladhani, Public Health England, London

Dr Mark Lawton, Royal Liverpool University Hospital

Dr Eithne MacMahon, Guy’s & St Thomas’ NHS Foundation Trust & King’s College London, London

Dr John McSorley, Central Middlesex Hospital, London

Dr Anton Pozniak, Chelsea and Westminster Hospital, London

Dr Alison Rodger, University College London

Introduction

These guidelines provide updated, GRADE-based recommendations on the use of vaccines in HIV-positive adults. Several factors have made the updating of HIV-specific vaccination guidelines important: effective antiretroviral therapy (ART) has substantially modified the natural history of HIV infection, vaccination practices are evolving, and a large number of novel vaccines are becoming available in clinical care.

The update contains important new guidance regarding the use of new vaccines against human papillomavirus (HPV), shingles (herpes zoster) and pneumococcus. Further key updates are related to the use of hepatitis B, meningococcus and pertussis vaccines.

Compared with HIV-negative individuals, HIV-positive adults often have an increased risk of infection or experience more severe morbidity following exposure to vaccine-preventable diseases, and therefore a lower threshold for extending indications and offering vaccination may be appropriate relative to the general population.

Improved health and prognosis mean that HIV-positive adults are also increasingly likely to engage in travel or occupations that carry a risk of exposure to infectious agents, and these otherwise healthy individuals should not be denied protection or engagement with such activities if evidence indicates vaccination is safe and immunogenic.

Immune responses to vaccination are often sub-optimal in HIV-positive patients, and while these improve with ART, they often remain lower and decline more rapidly than in HIV-negative individuals.

However, many of these vaccines still afford protection and for some vaccines it is possible to improve immunogenicity by offering modified vaccine schedules, with higher or more frequent doses, without compromising safety.

Since their publication, these guidelines have been endorsed by the British Infection Association (BIA), European Clinical AIDS Society (EACS) and the Royal College of General Practitioners (RCGP).

PDF

http://www.bhiva.org/documents/Guidelines/Vaccination/2015-Vaccination-Guidelines.pdf

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Entry filed under: CONSENSOS, GUIDELINES, HIV/SIDA, HIV/SIDA Prevencion, Infecciones virales, Inmunizaciones, REVIEWS, Update.

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