3.30 MB - Academy of Medicine of Malaysia

MANAGEMENT OF HIV INFECTION IN CHILDREN
Immunogenicity of BCG is difficult to assess as there is no good marker. In
a cohort study in Rwanda, tuberculin skin test was positive in only 37% of
HIV infected infants compared to 70% in infants born to HIV-uninfected
mothers. 71, Level 6 There are very little data on the effectiveness of BCG in HIV
infected children. A small case control study 77, Level 7 did not show any protection,
but the study did not have sufficient power to detect possible protection
against TB meningitis or military TB. Two adult studies showed some benefit
in HIV infected adults who had received BCG during childhood. Marsh et al
78, Level 7 noted adults with clinical AIDS in Trinidad who received BCG during
childhood have a reduced risk of developing bacteremic TB (2% vs 10%).
Arbelaez et. al 79, Level 7 found overall 22% protection from all forms of TB.
b) Polio
Oral Polio Vaccine (OPV) is a live-attenuated vaccine. Vaccine-associated
paralytic poliomyelitis (VAPP) is a serious but fortunately rare complication
of the vaccine. Despite its extensive use in many countries in the world,
there have only been 2 case reports of HIV infected children developing
VAPP after OPV. 80, Level 9; 81,Level 9 In contrast, Inactivated Polio Vaccine (IPV) is
not associated with VAPP. Although the risk to the child following OPV may
be low, he/she may continue to excrete virus in the stools for some weeks
after vaccine. This may pose potential risk to close contacts who may be
immunocompromised (e.g. parents or siblings who may be HIV infected).
Thus it is recommended that IPV be given to HIV affected or infected
children. IPV is provided free on request from any government health clinic.
Both vaccines are immunogenic and in studies >90% of HIV infected
children developed protective antibodies after 3 doses of the vaccine
although the geometric mean antibody titre (GMT) was lower than in
69,Level 6; 82,Level 6
non-infected individuals.
c) Measles, Mumps, and Rubella (MMR)
MMR vaccine is a live-attenuated vaccine. The risk of adverse reactions
following vaccination was no different for HIV infected (treated and untreated)
and uninfected children. 83, Level 6;84,Level 6, 85,Level 6;86,Level 6;87,Level 8 Only one serious
adverse event has been reported in a HIV infected man with a CD4
lymphocyte count