Abstract

PIP: Some significant studies reported in the world literature which provide a scientific basis for immunization policy for those children known to be infected with human immunodeficiency virus (HIV) are reviewed. The review covers current experience with immunization of children infected with HIV along with relevant data on immunization of HIV-infected adults and in vitro studies with vaccine antigens and HIV-infected cells. Live vaccines have been contraindicated in children with immunodeficiency diseases because of the potential for disseminated infection with either the viral or bacterial vaccine strain. The assessment of a similar risk in HIV-infected children is complicated by the fact that it is not always known whether HIV-infected children actually are immunodeficient when immunized. Generally, inactivated vaccines are not considered to present a risk to immunodeficient children, but questions have been raised regarding the potential for any immunization to accelerate the course of HIV infection. Consequently, the safety of inactivated vaccines must be considered also. Local reactions and disseminated disease have been describe in HIV-infected individuals. The rate of dissemination of BCG cannot be determined from the available case reports, but they suggest the possibility of an increased risk for this otherwise unusual complication of BCG immunization. Limited data suggest that live measles vaccine doses not cause severe complications in children with HIV infection. Both reports from the US and Europe have failed to document adverse reactions to either live oral or inactivated polio vaccines. No side effects of DPT vaccine were noted in 2 published reports from Europe and the US. Available data on immunogenicity in children and adults show that both primary and secondary antibody responses to immunization are attenuted in the presence of HIV infection. This is particularly the case when immunodeficiency is present. It has been difficult to assess vaccine efficacy in HIV-infected children from industrialized nations due to the relatively low incidence of both vaccine-preventable disease and HIV infection. Only preliminary studies on vaccine efficacy are available from developing nations. This review offers some general support for the recommendations on immunizations of HIV-infected children that were developed by the World Health Organization and the Advisory Committee on Immunization Practices of the US Public Health service. For asymptomatic HIV-infected children, both groups recommend continued administration of standard vaccines. For symptomatic HIV-infected children, both groups recommend continued administration of inactivated vaccines but differ in their recommendations on live vaccines.