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