HAS recommendations

The response to vaccines in people living with HIV (PVVIH) can be altered. However, especially if the viral load is detectable or if the CD4 lymphocytes rate is low. However, these patients are more likely to develop avoidable infections: flu, pneumococcus, human papillomavirus (HPV), hepatitis, zona, etc. Moreover, Vaccination is therefore an essential prevention lever, with patterns to be adapted. For example, This new guide. Nevertheless, requested by the National AIDS Council and Viral Hepatitis (CNS) and the National AIDS Research Agency and Viral Hepatitis/emerging infectious diseases (ANRS/MIE), makes it possible to make a practical reminder, in order to help health professionals identify specific situations and advise this act correctly.

Identify immune status – Recommendations

Before any vaccination recommendation. In addition, in particular a living vaccine or in the event of a travel project, it is essential to know the patient’s immune status. In addition, Is it under antiretroviral treatment? Does recommendations he have immunosuppression?
The recommendations vary depending on several parameters: CD4 rate (threshold often set at 200/µl in adults). controlled viral load, age, pregnancy or comorbidities. This makes it possible to validate. rule out a contraindication and to determine whether a specific vaccine scheme is necessary.

Recommended vaccines – Recommendations

Several vaccines are systematically recommended in adults living with HIV. regardless of their immune status, as they target frequent or more severe infections for this population.

• Against seasonal flu : 1 annual dose of an inactivated antigripping vaccine. Prefer Efluelda in adults aged 65 and over.
• Against the COVVI-19 : same calendar than as a general population.
• Against diphtheria. tetanus, polio and darling : 1 dose at 25 with Boostrixtera or Repevax, then every 10 years (interval shorter than in general population).
• Against pneumococcal infections : 1 Prevenar 20 dose, including in case of prevening vaccination antencedents 13 or Pneumovax.
• Against invasive meningococcal infections : a vaccine against meningococcus B (2 doses at recommendations 1 month of BexSero interval. 2 to 3 doses, according to the diagram, of Trumenba) and a vaccine combined against the Acwy meningococci (1 dose of nimenrix, Menveo or Menquadfi).
• Against HPV infections : Gardasil 9 up to 26 years old, with a 3 doses diagram (M0, M2, M6).
• Against syncytial respiratory virus infections (VRS) : 1 dose of Abrysvo. Arexvy, according to the same recommendations as in general population, that is to say either from 65 years when there is comorbidity, if not in all people aged 75 and over.

Under conditions vaccines

Some vaccines can be administered in PVVIH only depending on the CD4 rate. immune status or the presence of specific risk factors. Their indication must therefore be evaluated on a case -by -case basis.

• For measles, mumps and rubella (ROR) : By priorrix or MMRVAXPRO, only if the CD4 level is ≥ 200/µl.
• For chickenpox : by Varilrix or Varivax, only if the CD4 level is ≥ 200/µl and non -immune patient.
• For yellow fever : The stamililian anti -arch vaccine is possible if the CD4 level is ≥ 200/µl.
• For hepatitis has : by Avaxim, Havrix or VAQTA, in non -immune PVVIHs and with risk factors.
• For hepatitis B : By Engerix B. HBVAXPRO, Recommended vaccination in all adults living with HIV if the serology of hepatitis recommendations B virus (VHB) is negative.

Serological follow -up is recommended after vaccinations against hepatitis A and B to assess the immune response.

• For bacterial meningitis (Hæmophilus influenzae de type b) : not specifically recommended in adults living with HIV. Follow the general indications according to a diagram at 1 dose of ACTHIB vaccine.
• For the vario of the monkey (Mpox) : by Imvansne. in pre-exhibition in certain populations at risk, according to a diagram in 2 or 3 doses depending on the CD4 rate.
• For the zona : in patients aged 65 or over, as well as in patients under 65 with a CD4 rate <200/ µl despite antiretroviral treatment well conducted for more than 6 months (2 doses of shingrix spaced 2 months).

Vaccines contraindicated

• Against tuberculosis : the BCG is contraindicated in all cases, regardless of the CD4 rate.
• Living vaccines (Ror, chickenpox, yellow fever, etc.) are contraindicated if the CD4 recommendations level is less than 200/μL in adults and children 5 years or more. Likewise in infants under one year if the percentage threshold is less than 25 %. among 1-2 year olds if it is less than 20 %, and in 3-5 year olds if it is less than 15 %.

Particular case of pregnant women

The recommendations are the same as for other pregnant women.

• Whooping : 1 dose from 20 weeks of amenorrhea (SA) by Boostrixtera or Repevax.
• Seasonal flu and covid-19 : 1 dose of each during pregnancy.
• VRS : 1 dose of Abrysvo between 32 and 36 SA. If the CD4 rate is <200/µl, it is advisable to prefer the immunization of the infant at birth for the VRS.

For children

• Mandatory vaccinations are maintained (except the BCG, still contraindicated).
• Rotavirus infection : vaccination is recommended only if the CD4 level is ≥ 200/µl (or at the % threshold in children).
• Strengthened patterns are recommended (for example, hexavalent vaccination DTCAPOLIOHIB-VHB with a 3-doses diagram at 2 months, 3 months and 4 months of infants).
• Living vaccines are authorized only if the CD4 thresholds are affected:
  • 25 % before 12 months.
  • 20 % between 12 and 35 months old,
  • 15 % between 36 and 59 months old,
  • ≥ 200/µl from 5 years old.

Summary tables (vaccine recommendations schemes, indications according to immunovirological status, etc.) are available in the complete HAS document.