Adverse Events After Vaccination Examined Among HIV-Positive Persons

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The most common reported adverse events reported in patients age 19 years or older were injection site reactions, pain, fever, and rash.
The most common reported adverse events reported in patients age 19 years or older were injection site reactions, pain, fever, and rash.

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 report published in Public Library of Science (PLOS) One.

A team of researchers 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 categorized as nonserious; that is, no deaths, life-threatening illness, hospitalization, or prolongation of existing hospitalization 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 immunocompromised status.   

This study may be limited by the passive surveillance system used by Vaccine Adverse Event Reporting System, characterized by variable reporting behavior. 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 immunocompromising conditions can potentially increase the risk of rare, but severe, AEs following vaccination with live virus vaccines.”

Reference

Su JR, Ng C, Lewis PW, Cano MV. Adverse events after vaccination among HIV-positive persons, 1990-2016 [published online June 19, 2018]. PLoS One. doi.org/10.1371/journal.pone.0199229

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