Specific recommendations to support vaccination in the event of HIV infection

For health professionals in charge of patients living with HIV.dragana991 / iStock/Getty Images Plus / via Getty Images

LA High Authority for Health (HAS) publishes a recommendation of good practice [1] relating to vaccination of People living with HIV (PVVIH).

It is aimed at all health professionals supporting these patients and involved in vaccination, with the objective of supporting them in the vaccination approach:

• Provide information to PVVIH concerning the recommended vaccinations, specifically recommended or compulsory (early childhood);
• update their vaccination status;
• Know the indications and terms of vaccinations in PVVIH.

This recommendation includes all PVVIH populations (infants, children, adults and pregnant women). For each of these three populations, the authors describe the administration patterns and the vaccination indications, in comparison with the applicable strategy in the general population. They specify the points of vigilance or the elements to be controlled before vaccinating.

The key elements to be remembered according to the type of vaccine

The first part of the recommendation sums up the specifics of security and postvaccinal immune response depending on the type of vaccine:

• inert vaccines :
  

  • They can be administered regardless of the CD4 rate, HIV viral load and antiretroviral treatment,
  • Nevertheless, the vaccine strategy can be reinforced (more frequent reminders for example) in immunologically controlled PVVIH. For example, a recall of vaccination against diphtheria, tetanus, polio and darling is recommended at 25 and then every 10 years, that is at shorter intervals than general population. Likewise, vaccination against invasive meningococcal infections B and ACWY is recommended in all adults Living with HIV (VVIH) due to a rudeness compared to the general population;

• Live vaccines attenuated :

  • They are contraindicated in the event of severe immune deficit in:

    • infants of less than 12 months: CD4 rate <25 %,
    • the child between 12 and 35 months old: CD4 rate <20 %,
    • the child between 36 and 59 months: CD4 rate <15 %,
    • The child from 5 years old and in adults: CD4 rate <200/ µl.

  • The protection obtained, of shorter, may require more frequent reminders than in the immunocompetent person,
  • Live vaccines attenuated bacterial (BCG) are contraindicated.

Necessary precautions and adjustments

In adults, the recommendation issued by the HAS relates to the following vaccinations:

• COVID-19
• diphtheria, tetanus, polio and dick
• yellow fever
• seasonal flu
• invasive infections at Haemophilus influenzae b
• hepatitis has
• hepatitis B
• Invasive Meningococcal Infections
• Human papillomavirus infections (HPV)
• Pneumococcal infections
• Syncytial respiratory virus infection (VRS)
• Mpox
• mumps, measles, rubella
• varicella
• area

For most of these infections, the recommended vaccination strategy in PVVIH is similar to that applicable in the general population, taking into account in some cases the CD4 rate (measles/oreillon/rubella for example, or pneumococcal infections).

In infants and children Vvethe recommendation relates to the same vaccinations as in adults (except VRS, MPOX and Zona), to which is added vaccination against infections to rotavirus.

Finally, In the pregnant woman VVIHthe recommendation describes the applicable strategy for pertussis vaccination, COVID-19, seasonal flu and VRS infection. For the first three vaccinations, there is no difference with the recommended strategy in the general population.

VS VRS infection is recommended in pregnant women VVIH according to the same methods as those in pregnant women in the general population, except in pregnant women VVIH having an uncontrolled viral load and/or CD4 <200/ µl at the time of the vaccine campaign. In the latter, for the prevention of VRS infection, it is recommended to favor the baby's immunization strategy by administration of specific antibodies [BEYFORTUS solution injectable seringue préremplie (nirsévimab) et SYNAGIS solution injectable (palivizumab) - pour les indications respectives se référer aux monographies VIDAL - cf. notre article du 1^er juillet 2025].

The abrysvo powder and solvent vaccine for intramuscular injection solution (antigen glycoprotein F of the syncytial respiratory virus) can be administered at the same time as a vaccine against seasonal flu or against the COVVI-19.

For the record, Table 4.4.2 in the vaccine calendar (pages from 74 to 78) [2] summarizing vaccination recommendations in immunocompromised peoplethat is to say those living with HIV, treated with chemotherapy and those receiving corticosteroid therapy.