Treating adverse events resulting from vaccinations in HIV-positive individuals

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Although HIV dysregulates the immune system, recent research does not indicate unexpected patterns of adverse events (AEs) resulting from vaccinations in HIV-positive individuals, according to a study.

A team of researchers led by John Su at the National Centre for Emerging and Zoonotic Infectious Diseases, US Centres for Disease Control and Prevention, Atlanta, searched the Vaccine Adverse Event Reporting System for reports from HIV-positive individuals made between 1990 and 2016. A total of 353 reports were identified for analysis.

Inactivated vaccines that were commonly administered included pneumococcal polysaccharide (27%) and inactivated influenza (27%) and live vaccines included combination measles, mumps, and rubella (8%) and varicella (6%).

Of the reports, 75% were categorised as nonserious; that is, no deaths, life-threatening illness, hospitalisation, or prolongation of existing hospitalisation resulted. Injection site reactions were reported in 39% of patients. There were 67 reports with documented CD4 counts. Of these, 61% described individuals who were immunocompromised, with CD4 counts <500 cells/mm3.

Failure of vaccination was documented in 72 reports, of which 6 occurred in individuals who were immunocompromised. Of these 6 individuals who were immunocompromised who failed vaccination, 3 received varicella vaccine.

There were 66 documented live vaccination reports. Of these, 7 were reports of disseminated infection, 6 of which were of varicella.

There were 18 reports of death, 7 resulting from disseminated infections. Of the deaths related to dissemination, 6 patients who were immunocompromised and 1 had varicella infection.

No AEs were noted among those with HIV that were unexpected based on HIV or immuno-compromised status.

This study may be limited by the passive surveillance system used by Vaccine Adverse Event Reporting System, characterised by variable reporting behaviour. Reporting biases, data inconsistencies, and underreporting are only some of potential problems.

“These data reinforce current vaccine recommendations for this risk group,” the investigators wrote. “However, healthcare providers should know their HIV-positive patients’ immune status because immuno-compromising conditions can potentially increase the risk of rare, but severe, AEs following vaccination with live virus vaccines.”

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.

Authors
John R Su, Carmen Ng, Paige W Lewis, Maria V Cano

Infectious Disease Advisor material
PLoS One abstract


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