Vaccination of HIV-infected people. Questions about vaccinations for HIV infection
The lives of HIV-positive people are not so different from the lives of those who do not have HIV. Perhaps they eat a little differently, take ARV drugs, but otherwise their lives are absolutely normal. However, some processes in the body of HIV-positive people proceed somewhat differently. Therefore, we asked ourselves how people living with HIV should be vaccinated correctly, and whether there are any differences.
Vaccination studies for people living with HIV are few and far between and have become less common since people started taking ARVs. But according to these studies, basic guidelines should be followed.
People with HIV are not advised to use “live” vaccines, i.e. vaccines that contain weakened microorganisms. For example, the smallpox vaccination is included in this category and can only be done if your doctor has agreed to the vaccination.
Most diseases, especially hepatitis B, influenza and some other diseases may have more negative consequences Therefore, the issue of prevention should be seriously considered. After prophylaxis, it is not advisable to take a viral load test for twenty-eight days.
Among the vaccinations for HIV-positive people, the most studied is the flu vaccine; it is safe and very effective for the body. However, HIV-positive people should not use the nasal spray as a vaccine because it contains “live” bacteria.
What vaccines are used for HIV patients:
From pneumonia. The risk of getting it in people living with HIV is much greater, for this reason it is worth taking prophylaxis against this infection (the vaccine is effective for 5 years).
From the flu. Very important for people with HIV. You should always get vaccinated before the outbreak of the epidemic (early November). The flu shot is valid for one year.
From hepatitis. Nowadays, there are only vaccines for hepatitis A and B. Hepatitis A is mainly harmful to people who have liver problems. Prophylaxis against hepatitis A with two vaccinations can protect you for twenty years.
From tetanus and diphtheria. Tetanus - serious illness caused by a bacterium. It is not transmitted from one person to another, but through skin wounds. Diphtheria also occurs from bacteria, but can be transmitted from person to person. Prevention against these infections is carried out together and usually in childhood. People with HIV are not recommended to be vaccinated more than once every 10 years.
From mumps, measles and rubella. The good news is that the vaccine against them is effective for life, but due to the fact that this is a “live” vaccine, harmful to HIV-positive people, the level of immunity must be checked before vaccination (the indicator must be at least 200 cells/ml).
Two weeks before vaccination, vitamin therapy is carried out to maintain immunity, since such prevention carries risks for HIV-positive people. But the whole process is under the supervision of the AIDS Centers.
Also, prevention is needed before traveling. Vaccinations against hepatitis A and B are required. Vaccination requirements must be taken into account different countries and remember that vaccines with “live” bacteria are not recommended.
In any case, you should consult your doctor before you get vaccinated.
Vaccination against HIV could save thousands of lives from imminent death, because according to statistics, at least 20 thousand people die from AIDS every year in Russia. Despite progress in science and medicine, the incidence is only growing every year. And in some regions the numbers are so high that doctors are talking about an HIV epidemic. Scientists in different countries are working on the problem, but so far the miracle vaccine remains only a theoretical development.
The HIV vaccine has not yet been invented, but it is predicted to appear in the next 5 years. This positive thought is interpreted by the media and the medical community. The latest developments by scientists and the study of retroviruses make it possible to create drugs that give almost 100% results in clinical trials. Probably, the future in solving this issue lies with genetic engineering. Geneticists have been able to completely decipher the genetic code of the retrovirus and offer hundreds of options for creating a vaccine.
The vaccine is not yet available to the general public and developments are only used for laboratory research. The most effective methods HIV prevention remains through contraception and taking antiretroviral drugs after possible infection. Post-exposure prophylaxis is carried out within the first 2 hours after the expected risk of infection, but no later than 3 days.
Western development of vaccines against immunodeficiency virus
- The development of HIV vaccines is progressing rapidly in the United States. In 1997, a state program to combat AIDS was created and scientific research related to the study of retroviruses. Sponsored from the country's budget. To date, about 100 vaccines are undergoing clinical trials. Some specimens have already shown encouraging results in experiments on monkeys.
- Those drugs that have passed all the necessary stages of testing are used to vaccinate volunteers in African countries, where the incidence of HIV is the highest in the world. For example, in Uganda they are testing the ALVAC vaccine, which affects cellular immunity and production large quantity macrophages that destroy HIV-infected cells.
- Another development of American scientists, the Aidsvax vaccine, passed its first clinical trials back in 2002. The Aidsvax vaccine is based on a retrovirus protein and helps the virus penetrate the cell through the protective membrane. Vaccination of people at risk in Thailand has reduced HIV incidence by 30%. The international community considered this percentage too low for the widespread use of the drug, so scientists are still working on it.
- Geneticists from Oregon announced successful tests of a vaccine created on the basis of simian herpes type 5, into the genome of which the genes of a highly pathogenic strain of HIV are integrated. Vaccination of more than 50% of experimental animals eliminated immunodeficiency.
- Created in Spain combination drug, capable of protecting against two infections at once - HIV and Hepatitis C. The vaccine is now undergoing all the necessary tests and improvements.
- Among the new approaches, the use of cowpox and equine encephalitis virus, modified in the right way forces genetic engineering. These viruses invade the body (still in the body of mice) and cause increased production of T-lymphocytes, necessary for the fight with HIV.
So far, all developments remain at the stage of clinical trials and the process of mass production of HIV vaccinations has not been launched. This is due to the need for many years of testing drugs, assessing the effectiveness and side effects on the human body.
Can HIV-infected people be vaccinated against other diseases?
Considering immunodeficiency state HIV-infected patients, the question arises about the possibility and safety of vaccinating patients against other diseases. Against the background of suppressed immunity, vaccination risks causing serious complications or even leading to a preventable disease. However, a person with HIV needs protection from various infections. After all, in a patient infected with a retrovirus, any disease is more severe and leads to death. It is worth highlighting several points that are pointed out to an HIV-infected person before vaccination:
- Patients with HIV vaccinations They do not follow the vaccination schedule. Even if a person was vaccinated in childhood, in case of immunodeficiency the vaccination is repeated.
- If the CD4 cell count is below 200 cells, the vaccine is ineffective and even dangerous. Antiretroviral therapy and stabilization of the immune system are necessary.
- With vaccination, an HIV patient's viral load increases, but this goes away after 3-4 weeks.
- Vaccination using “live” preparations is contraindicated ( chicken pox, mumps, measles, tularemia).
- The flu vaccine for HIV infection is done annually in October - early November without the use of “live” vaccines.
- Vaccinations against pneumonia, hepatitis, tetanus, diphtheria and meningitis are mandatory for HIV patients.
Vaccinations for HIV patients are carried out under supervision at AIDS Centers. Before and after vaccination, antiretroviral and vitamin therapy is necessary to maintain immunity and prevent complications.
IS IT POSSIBLE TO IMMUNIZE AIDS PATIENTS?
V.V. Pokrovsky
Russian Scientific and Methodological Center for Prevention
and the fight against AIDS, Moscow
Following the identification of the first cases of acquired immune deficiency syndrome (AIDS), in which patients die from infections caused by opportunistic flora that are of little danger to healthy people, a completely natural assumption was made that the administration of even “weakened” vaccine strains to AIDS patients could lead to severe consequences. In addition, it was noted that one of the features of immunity disorders in AIDS patients is a decreased immune response to new antigens, and vaccination of AIDS patients may not have any effect at all. The conclusion was drawn: since vaccination is dangerous and useless, it is better not to carry it out at all.
The discovery of the human immunodeficiency virus (HIV), which causes AIDS, and long-term study of the characteristics of the course of the disease led to a revision of views on this problem. It turned out that significant immunity disorders are characteristic of the late stage of the disease (5-10 or more years after HIV infection). The degree of immune deficiency is determined primarily by the number of cells carrying the CD4 receptor. As long as there are more than 500 of these cells per mm. cube (0.5 in ml according to the SI system) of blood, the immune system is functioning fully. When the cell count is less than 500, but not lower than 200, immunity is already reduced, relatively easily treatable opportunistic infections may appear, and a response to new antigens is still quite possible, although it may be reduced. Decrease in the number of CD4 cells to less than 200 per mm. cube blood (less than 0.2 per ml) undoubtedly poses a threat to life, since there is the possibility of developing fatal dangerous infections. But the dangers for HIV-infected people are not influenza, measles or mumps and other diseases for the prevention of which vaccination is used, but, with rare exceptions (tuberculosis), precisely those for the prevention of which vaccines have not been developed. In addition, although complications after vaccination in HIV-infected people have been described, statistical analysis does not reveal an absolute increase in the number of severe post-vaccination processes among HIV-infected vaccinated people (prior to the diagnosis of HIV infection), compared with the other population. Therefore, most modern researchers admit the possibility of effective and safe vaccination of HIV-infected individuals with killed vaccines. The issue of vaccination with live vaccines is on the agenda. It is known that vaccination may be accompanied by a short-term decrease in the number of CD4 cells. With the start of use in the clinic new technique Determining the concentration of HIV RNA in the blood ("viral load"), the issue of vaccination took on a new perspective. Currently, this indicator is used to determine the effectiveness of treatment (successful therapy leads to its reduction). After vaccination, an increase in HIV RNA concentration is often observed, as well as after past illness. This can be misleading for doctors, especially since it is not yet known how these temporary fluctuations affect the prognosis of the disease.
On the other hand, in most countries of the world it is not possible to determine either the number of CD4 cells or, especially, the viral load. There is not even a way to diagnose HIV infection. In economically underdeveloped Africa, with a level of HIV infection among pregnant women of 5-10%, it is unlikely that all children will be screened for HIV, and infected children will be screened for CD4 cell counts, much less for their “viral load.” In Africa, for example, preventive vaccinations carried out to all children without exception for pragmatic reasons.
But even in developed countries there are financial prerequisites for vaccinating HIV-infected people. For example, in the case of an HIV-infected person with influenza, it is necessary to carry out complex and expensive differential diagnosis between influenza and many opportunistic infections that occur with fever.
IN general view, modern recommendations boil down to the fact that HIV-infected people can be vaccinated with inactivated vaccines, and it is permissible to be vaccinated using “live” vaccines. Exceptions to this rule are allowed when we're talking about about vaccinations in outbreaks. In particular, BCG is sometimes recommended for children with high risk tuberculosis infection. Regarding measles vaccination, many experts believe that the likelihood of a child dying from measles is so high that it can be neglected possible complications. However, some developed countries are still holding back from a final solution to this problem. However, in cases of travel to areas of dangerous infections, such as yellow fever, vaccination with a live vaccine is, in principle, allowed, but taking into account the condition of the person being vaccinated.
In Russia, the issue of vaccinating children born to HIV-infected mothers has become a serious problem in recent years, due to an increase in the number of infected women childbearing age. Directive documents on vaccination of HIV-infected people published in Russia are somewhat contradictory and diverge from the publications of individual authors. The matter is further complicated by the fact that it is possible to determine with certainty whether a child is infected with HIV or not only by the 18th month, since maternal antibodies to HIV are present in all newborns from HIV-infected women. The use of methods for detecting HIV genetic material, in particular using polymerase chain reaction, does not always give an earlier result. Besides, this method not yet fully available. However, after it has been established that the child is definitely not infected with HIV, he can be vaccinated according to an individual schedule, bringing him closer to the vaccination calendar.
If inactivated vaccines can be administered to HIV-infected people according to the vaccination schedule and according to indications, then with vaccinations with live vaccines the situation is more complicated. WHO currently makes the following recommendations: BCG vaccination for children born to HIV-infected mothers is allowed according to epidemic indications. An inactivated vaccine is used for vaccination against polio. Vaccination with live measles and mumps vaccines is recommended according to the calendar, especially in cases where children are organized in groups and outbreaks of diseases are possible. In addition to regular vaccinations, due to the increased incidence of pneumococcal infections in HIV-infected people, appropriate vaccination is recommended. For the same reason, vaccination of children against Haemophilus influenzae is recommended. When carrying out vaccinations, HIV-infected people should be guided by the regulatory documents approved by the Ministry of Health of the Russian Federation.
Recent data on the effectiveness of preventing mother-to-child transmission of HIV, due to which the probability of the birth of an infected child is reduced to 0-5 percent, allows us to hope that the problem of vaccinating children born from HIV-infected mothers, while maintaining a sufficiently large number (more than 500 per mm3) immune cells, carrying the CD4 receptor, will soon cease to be relevant.
Because HIV infection leads to progressive deterioration immune system There is concern that some vaccines may cause serious post-vaccination complications in HIV-infected patients.
5. Basic principles of vaccination of people with HIV infection:
1) when a diagnosis of HIV infection is established, vaccination is carried out after consultation with a doctor at the AIDS center;
2) killed and other vaccines that do not contain live microorganisms or viruses do not pose a danger to people with impaired immune systems and should generally be used on the same principles as for healthy people;
3) vaccines against tuberculosis, polio, yellow fever, monovaccine against measles, mumps, rubella, combination vaccines containing these live attenuated viruses, as well as other live vaccines are contraindicated in HIV-infected people with moderate to severe immunosuppression, patients with symptomatic HIV infection and in the AIDS stage;
4) in HIV-infected people who do not have symptoms or have mild signs of immunosuppression, vaccination with live vaccines should be carried out in the same way as in those not infected with HIV;
5) vaccination of children born from an HIV-infected mother is carried out after consultation with a doctor at the AIDS center.
6. Vaccination against tuberculosis:
1) newborns born from HIV-infected mothers in the absence clinical signs HIV infection and other contraindications to the administration of this vaccine are vaccinated with a standard dose of the BCG vaccine;
2) newborns born from HIV-infected mothers who were not vaccinated maternity wards within regulated periods, can be vaccinated during the first four weeks of life (newborn period) without a preliminary Mantoux test;
3) after the fourth week of life, administration of the BCG vaccine to children born from HIV-infected mothers is not allowed, since if the child is infected with HIV, the increasing viral load (about 1 billion new viral particles are formed during the day) and the progression of immunodeficiency can lead to development of generalized BCG infection. For the same reason, repeated BCG vaccination children with undeveloped post-vaccination signs until a final conclusion is made as to whether the child is infected with the immunodeficiency virus or not;
4) BCG revaccination is not carried out for HIV-infected children due to the risk of developing a generalized BCG infection against the background of increasing immunodeficiency;
5) a child born from an HIV-infected mother, but not
who is HIV-infected is allowed to BCG revaccination V
calendar dates after a preliminary Mantoux test if its results are negative.
7. Vaccination against measles, rubella and mumps:
1) vaccination against measles, rubella and mumps is contraindicated for HIV-
infected children and adults with moderate to severe
immunosuppression, symptomatic HIV infection and stage of AIDS;
2) vaccination against measles, rubella and mumps is carried out for HIV-infected patients with an asymptomatic stage or with mild immunosuppression in accordance with the national vaccination schedule;
3) in a situation where the risk of measles spread is high, the following strategy is recommended: children aged 6-11 months are administered measles monovaccine, and at the age of 12-15 months, vaccination is repeated using a combined vaccine against measles, rubella and mumps or another combined vaccine containing measles component;
4) HIV-infected people with clinical manifestations at risk
contracting measles, regardless of whether they are vaccinated against measles or not,
should receive immunoglobulin.
8. Vaccination against polio:
Live OPV should not be administered to HIV-infected people, regardless of the degree of immunodeficiency, as well as to members of their families and persons in close contact with them. In these cases, replacement is indicated OPV vaccines on IPV.
9. Vaccination against typhoid fever:
should not be prescribed to HIV-infected people (children and adults), regardless of the severity of immunodeficiency.
10. Vaccination against yellow fever:
prescribed to HIV-infected children and adults, regardless of clinical stage and severity of immunodeficiency only if the benefit of vaccination outweighs the risk.
11. Vaccination with killed and other vaccines that do not contain live
weakened strains of microorganisms and viruses:
1) HIV-infected children, regardless of the clinical stage and
immune status must be vaccinated DPT vaccine with cellular or
acellular pertussis component according to the calendar and recommended
doses;
3) hepatitis A vaccination (one dose plus a booster dose 6 to 12 months after the first dose) is recommended for people at risk for hepatitis A, regardless of HIV status or immune system status;
4) vaccination against hepatitis B is indicated for all HIV-infected people who do not have serological markers of hepatitis B (HBsAg). At the same time,
The vaccination schedule should be applied in accordance with the CD4 lymphocyte count:
if the number of lymphocytes CD4>500/microliter (hereinafter referred to as µl), vaccination begins with a standard dose of 20 micrograms (hereinafter referred to as µg), the vaccine is administered at 0, 1, 2 and 12 months or 0, 1 and 6 months; The vaccine dose for children is 10 mcg;
if the CD4 lymphocyte count is 200-500/µl, vaccination is carried out according to an intensive regimen (20 µg) at 0, 1, 2 and 12 months;
Patients who do not respond to the first course of vaccination are given additional doses of the vaccine or full course vaccination using a dose of 40 mcg;
if CD4 count<200/мкл и ВИЧ-инфицированный не получает antiretroviral therapy(hereinafter referred to as APT), APT is started first. Vaccination is delayed until CD4 recovery > 200/μL;
12. To the contingent vaccinated against hepatitis B, In addition to HIV-infected people, these include: household contacts living with an HIV-infected person; personnel caring for and in close contact with HIV-infected people.
14. Vaccination against meningococcal infection: vaccination
recommended for all persons planning to travel to countries
endemic for meningococcal infection, regardless of their HIV status.
15.Vaccination against rabies: Rabies vaccination is not
Contraindicated for HIV-infected persons.