Immunizations

Vaccines play an important role in protecting older adults with HIV from serious illnesses caused by bacteria and viruses. The use of vaccines has an important effect both for the individual and the public health of the community. However, even if well treated with ART and having a high CD4 count, older adults with HIV have characteristics that require special attention. Both at older ages without HIV and because of the lasting effects of the HIV virus, the immune system, is compromised. There are various strategies to address these limitations and to obtain satisfactory effects from vaccines. These include the use of higher doses of the vaccines and more than one dose for treatment.

Vaccines work by generating antibodies in the body that can attack certain bacteria or viruses. There are two types of vaccines. One is called “inactivated” vaccine and can be used no matter what levels of immunosuppression exists, as indicated by a low CD4. The bacteria or viruses used in developing the vaccine have all been killed. Common vaccines of this class are tetanus and influenza. The second type is “live- attenuated organism”. These vaccines may still have some active bacteria or virus present after development of the vaccine, but these are weakened. However, those bacteria or viruses could cause problems in an older adult with HIV. Vaccines of this class are used for mumps and measles. The good news is that a CD4 count greater than 200 will qualify a patient for safe immunizations.

What you should know and do

Because of the complexities surrounding which vaccinations you may need, a discussion with your medical provider is needed. This is necessary because the FDA (Food and Drug Administration), which sets the standards for immunizations, has not provided guidance for older persons with HIV. It would be best to follow the general recommendations for your age group. An example is the vaccination for herpes zoster (shingles). There is a new vaccine that is not a “live” vaccine and is indicated for all people 50 years and older. It has been tested in older persons with HIV and found to be effective with a perhaps greater effect in those with a higher CD4 count. For yearly influenza vaccine administration, the FDA has approved a new stronger product that can increase the antibody

response against influenza. However, in this case, it is only approved for all persons older than 65 years of age and not for younger persons with HIV, even if there has been a suggestion that it is better. Again, this will require consultation with your physician. Finally, there are outbreaks of measles occurring in the USA. Should an older adult with HIV be vaccinated? Most older persons with HIV probably have had measles as youngsters. But if there is a question about whether this had occurred or whether one is vulnerable, then the combination mumps, measles and rubella vaccine can be used if the CD4 count is greater than 200.

If you or your doctor want to obtain more detailed information about vaccinations in older persons with HIV, there is a summary at the American Academy of HIV Medicine website. Click here: “Immunization” at “Recommended Treatment Strategies”

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