Implementation of EACS vaccination recommendations among people living with HIV

Abstract

Objectives: With modern combination antiretroviral Treatment (cART) a normal life expectancy among people living with HIV (PLWH) has become reality if started early enough prior to the onset of more pronounced immunodeficiency. Therefore, prevention measures against other infectious diseases among this vulnerable group have gained increased attention. Indeed, the EACS guidelines recommend vaccinations against HAV, HBV, HPV, Influenza, Neisseria meningitidis, Streptococcus pneumoniae and VZV in HIV-infected adults.

Methods: All PLWH under cART attending our ID outpatient clinic between April to June 2018, were assessed during consultation for vaccination status regarding pneumococcus, Hepatitis A and B, influenza, varicella, meningococcus and HPV using a pre-defined questionnaire, vaccination certificates and medical records. In addition, the cohort database was screened for Hepatitis A and B serology and HIV surrogate markers.

Results: A total of 305 PLWH (82.3% male, 17.7% female) was included, median age was 48 years (IQR 47-51). Median CD4 + T cell count was 543 (IQR 304-770), and for 297 (97.4%) PLWH CD4 + T cell count was ≥ 200/ul. The viral load was undetectable (< 40 copies/ml) in 289 (94.8%) cases. Highest vaccination rates were observed for HAV (87.4%), Streptococcus pneumoniae (77.4%) and Influenza (76.5%). 64.3% PLWH got vaccinated against HBV, whereas VZV vaccination only played a minor role, in the context of the high rate of cleared infections (99.0%). Lowest vaccination rates were detected for HPV (0%) and Neisseria meningitidis (3.0%).

Conclusions: Our data suggest that vaccination rates among PLWH are higher compared to the general German population. Implementation of EACS guidelines into daily routine though is not fully executed and the need for improving vaccination rates has to be emphasized. Centrally organized vaccination registers as well as electronic medical records could be helpful tools to detect a lack of vaccination coverage and send digital vaccination reminders particularly among risk groups.

Keywords: AIDS; HIV; Prevention; Vaccination.

Fig. 1

Vaccination against seasonal Influenza was high, with 76.5% of all participants having a received a current flu shot. In the subgroup of PLWH 60 years and older, vaccination coverage in our analysis was even higher (83.3%). A difference between the two genders in this subgroup was not detected

Fig. 2

With 64.9% (194) of the participating patients, almost two thirds were vaccinated against Hepatitis A. For another 9.4% (28) antibodies could be detected after undergoing an infection. In 25.8% (77/299) of the PLWH of this study no protective antibodies, correlating with an unvaccinated status, had to be observed

Fig. 3

7.0% (21) of the PLWH participating in this study had a chronic HBV infection, while 23.5% (70) were able to clear an HBV infection at some earlier point. From the remaining 207 patients being eligible for vaccination, 64.3 (133) were vaccinated

Fig. 4

In total, 77.4% (236) of the patients had been vaccinated against Streptococcus pneumoniae. 58.5% (138/236) of them followed the preferred regime with CPV-13 initially and PPV-23 administration at least 6 months after the first dose. 27.5% (65/236) received only one CPV-13 dose without any further vaccination. A general recommendation for a booster dose does not exist to date, though national guidelines are heterogenous