VACCINATION RECOMMENDATIONS FOR HIV-1-INFECTED CHILDREN

Recommendations for the vaccination of HIV-1-infected children have be en made by the Advisory Committee on Immunization Practices and the Wo rld Health Organization, and are reviewed in this article. The data on immunogenicity and safety of individual vaccines are also reviewed. I n evaluating the risk of immunisation, it appears that HIV-1-infected children have a very low incidence of vaccine-induced illness after ad ministration of live vaccines such as bacille Calmette-Guerin (BCG) or measles-mumps-rubella (MMR). Rates of the common adverse reactions ar e similar in HIV-1-infected and noninfected children. The immunogenici ty and efficacy of the vaccines appears to be lower in HIV-infected ch ildren, However, a high proportion of asymptomatic HIV-infected childr en are able to mount protective levels of antibodies following vaccina tion, The ability to respond to vaccines correlates with the stage of HIV infection. Children with severe immunodeficiency have the lowest r esponse rates and the most rapid decline of protective antibodies. Vac cination of HIV-infected children early in life before the onset of se vere immunodeficiency, as well as the administration of additional boo ster vaccines, might increase the efficacy of vaccinations in HIV-infe cted children. Recommendations for vaccinating HIV-1-infected children are based on the general principles of active and passive immunisatio n, as well as on the data acquired on vaccine safety and efficacy thro ugh the immunisation of HIV-1-infected children. These recommendations attempt to balance the risks and benefits of immunisation of these ch ildren in order to achieve optimal levels of protection against infect ious diseases. The Advisory Committee on Immunization Practices (ACIP) has published its recommendations for persons with altered immunocomp etence.([1]) These recommendations, however, are for use in the US and for areas with similar epidemiology. The World Health Organization ha s made different recommendations for developing countries with a high prevalence of wild poliovirus infection and tuberculosis in respect of the use of the oral polio vaccine (OPV) and bacille Calmette-Guerin r in (BCG).([2]) In this article the current recommendations for vaccina tion of HIV-1-infected children will be reviewed. Furthermore, the imm unogenicity and safety of individual vaccines will be discussed.