HAS recommendations – How to vaccinate people living with HIV?

The High Authority for Health (HAS) has published a Recommendation of good practices on the vaccination of people living with the human immunodeficiency virus (PVVIH). This vaccination represents an important issue for these patients due to a sensitivity to infections in principle greater compared to the general population. However, this risk is variable depending on several factors, notably ” of CD4 nadir, CD4 rate, HIV viral load and comorbidities ». A priori, All PVVIHs are therefore concerned: infants, children, adults, pregnant women.

In practice, we must first distinguish the types of vaccines

• Inert vaccines can be administered, regardless of the CD4 rate, HIV viral load and antiretroviral therapy. Ideally, it is better to administer them “ When the HIV viral load is undetectable, and if possible when the CD4 rate is at least more than 200/μl ». Or, « It is PVVIH whose immuno-virological status is not optimal that have the incidence of highest infections and complications, and therefore the most potential benefit of vaccination. During vaccine campaigns, the vaccinations concerned (COVVI-19, seasonal flu, VRS infection, etc.) should therefore not be deferred. »
• Live viral vaccines attenuated are contraindicated in the event of severe immune deficit:
  • In infants under 12 months of age: CD4 rate <25 %;
  • In children between 12 and 35 months: CD4 rate <20 %;
  • In children between 36 and 59 months: CD4 rate <15 %;
  • In children from the age of 5 and in adults: CD4 rate <200/μl.
• The BCG is contraindicated in all PVVIH.

What vaccines are recommended in adults VVIH whose HIV viral load is not controlled (> 50 copies/ml)?

• Covid-19: Vaccination always recommended, regardless of the CD4 rate.
• Seasonal flu: vaccination recommended during epidemic periods, regardless of the CD4 rate.
• VRS infection: Vaccination recommended during epidemic periods in patients ≥ 75 years or patients ≥ 65 years with comorbidities.
• Diphtheria, tetanus, polio, diet: recall vaccination at 25, then every 10 years (interval shorter than general population).
• Haemophilus influenzae de type b : Vaccination not recommended, but possible depending on recommendations in adults in general population.
• Hepatitis A: Recommended vaccination in non-immune patients vis-à-vis the VHA and at risk of exposure to VHA (men with sex with other men [HSH]Drug users in IV, travel in endemic zone) and/or co-infection by HBV or HCV and/or chronic hepatopathy or hepatobiliary or cycling-cubiScidosis.
• Hepatitis B: Recommended vaccination in the absence of HBV serological marker.
• Invasive Meningococcal infections: recommended vaccination.
• HPV infections (human papillomavirus): vaccination recommended up to 26 years old in patients who have not been vaccinated beforehand.
• Pneumococcal infections: recommended vaccination.
• MPOX: vaccination not recommended, but possible.
• Zona: recommended vaccination.
• Yellow fever, ROR (measles, mumps, rubella), chickenpox:
  • CD4 rate <200 μ/L: contraindicated vaccination;
  • CD4 rate ≥ 200 μ/L: vaccination possible.

What are the recommended vaccines in vvih adults whose viral load is controlled (<50 copies/ml)?

• Covid-19:
  • CD4 rate <200 μ/L: recommended vaccination;
  • CD4 rate ≥ 200 μ/L: vaccination recommended according to the same indications as in general population.
• Diphtheria, tetanus, polio, diet: recall vaccination at 25, then every 10 years.
• Seasonal flu: vaccination recommended during epidemic periods, regardless of the CD4 rate.
• Yellow fever, ROR (measles, mumps, rubella), chickenpox:
  • If CD4 rate <200 μ/L: contraindicated vaccination;
  • CD4 rate ≥ 200 μ/l and <500 μ/L: vaccination not recommended, but possible;
  • CD4 rate ≥ 500 μ/L: vaccination recommended according to the same indications as in general population.
• Haemophilus influenzae type B, hepatitis A, HPV infections:
  • CD4 rate <500 μ/L: vaccination not recommended, but possible;
  • CD4 rate ≥ 500 μ/L: vaccination recommended according to the same indications as in general population.
• Hepatitis B, invasive meningococcal infections, pneumococcal infections:
  • CD4 rate <500 μ/L: vaccination not recommended, but possible;
  • CD4 rate ≥ 500 μ/L: recommended vaccination.
• VRS infections: vaccination recommended during epidemic periods in patients ≥ 75 years or patients ≥ 65 years with comorbidities.
• Mpox:
  • CD4 rate <500 μ/L: vaccination not recommended, but possible;
  • CD4 rate ≥ 500 μ/L: vaccination recommended according to the same indications as in general population.
• Zone:
  • CD4 rate <200 μ/L: recommended vaccination.
  • CD4 rate ≥ 200 μ/L: vaccination recommended in patients ≥ 65 years.

In pregnant women VVIH, the recommended vaccines are those directed against COVID-19, darling, as well as seasonal flu during epidemic periods. For VRS infection, it is necessary to favor the strategy of immunization of the newborn at birth by specific antibodies against the VRS, except in epidemic period, where vaccination is recommended in patients whose viral load is controlled (<50 copies/ml) and whose CD4 rate is ≥ 500 μ/l.

In infants and VVIH children, ” Compulsory and recommended vaccinations are those of the general population, with the exception of the BCG (Living Vaccine attenuated) which is contraindicated, whatever their immune status ». The indications and contraindications of the other alive vaccines attenuated (yellow fever, seasonal flu, rotavirus, Ror, chickenpox) depend on the age of the child, the control of its viral load and its CD4 rate.

For more information on vaccination patterns, we invite you to refer to the tables published in the Recommendation of good vaccination practices for people living with HIV of the has.