3.30 MB - Academy of Medicine of Malaysia

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MANAGEMENT OF HIV INFECTION IN CHILDREN There are minimal data on the protective efficacy of MMR vaccine in HIV infected individuals. Experience in African countries has noted a reduction in measles incidence in regions with high HIV prevalence by maintaining 92,Level 9 high immunisation rates and periodic supplementary campaigns. d) Hepatitis B Hepatitis B vaccine is a recombinant vaccine. No significant adverse events were noted in cohort studies of infants receiving primary immunisation from 93,Level 6;94,Level 6 birth. Studies on the immunogenicity of hepatitis B vaccine have demonstrated poorer response rate in HIV infected infants and children with only 25-50% developing 95,Level 6;96,Level 6;97,Level 6;98,Level 6 protective antibodies after primary immunisation. Booster doses or higher doses have not been found to be immunogenic. 99,Level 6;98,Level 6 There are no studies of the protective efficacy of hepatitis B vaccine in HIV infected children. e) Haemophilus influenzae type B (Hib) Hib is a conjugated polysaccharide vaccine. The vaccine is safe and immunogenic in HIV infected infants and children (although the immunogenic response is less than that seen in normal children. 99,Level 4; 100,Level 6; 101,Level 6 Two recent studies from South Africa suggest that Hib vaccine is effective in protecting from invasive Hib disease although the level of protection is lower 102,Level 6;103, Level 6 than that seen in uninfected children (43.9-54.7% vs 83-90.8%). f) Diphtheria, Tetanus, Pertussis (DTP) DTP vaccine is safe and immunogenic in HIV infected infants and children. 82 ,Level 6;69,Level 6; 104,Level 6; 105,Level 6 However, GMTs achieved were lower than those in non-infected infants. There is no rigorous study on the protective efficacy of DTP vaccine in HIV infected children. g) Pneumococcal vaccine Children infected with HIV have a markedly increased risk of pneumococcal infection - from 2.8 to 12.6 times the rate compared with those who are not .106, Level 8;107,Level 6;108,Level 6; 109,Level 7 HIV infected. Both pneumococcal polysaccharide (PPV) and pneumococcal conjugate 110, Level 4; 111, Level 4 ;112, vaccines (PCV) are safe in HIV infected infants and children. Level 6 Approximately 65-100% of HIV infected children developed protective antibody after vaccination with PCV but GMTs achieved were lower than 113, Level 6; 112, Level 6; 111, Level 4 those in uninfected children. The response to the polysaccharide vaccine is generally poorer than to the conjugate vaccine. 111, Level 6; 115, Level 6 A large RCT from South Africa showed PCV provided 65% protection against invasive pneumococcal disease among 116, Level 2 HIV infected infants. 13
MANAGEMENT OF HIV INFECTION IN CHILDREN In a retrospective case-control study among adults from Spain 117, Level 6 , ART and PPV were found to have a significant, independent protective effect against pneumococcal disease, regardless of CD4 lymphocyte count. It was therefore concluded that all patients (adults) with HIV infection should be vaccinated with PPV vaccine to prevent pneumococcal disease. Table 1: Pneumococcal Vaccination Schedule for Children at Special Risk Age Conjugate vaccine Polysaccharide vaccine 2-6 months 7-11 months 12-23 months 3 doses, 2 doses, monthly intervals monthly intervals Further dose in second year of life Then after 2 nd birthday single dose of 23-valent When both conjugate and polysaccharide vaccines are used, the polysaccharide vaccine should be given at least two months after the last dose of conjugate vaccine h) Meningococcal vaccine So far, there are no data available on the response of HIV infected infants and children to meningococcal polysaccharide or conjugate vaccines. i) Varicella vaccine This is a live-attenuated vaccine. The vaccine is safe and thus far, no increase in adverse reactions compared to normal controls have been noted. 118, Level 6; 119, Level 6 However, the studies on safety excluded those with severe immunosuppression. The vaccine induced good immunogenicity in HIV infected children with 60-79% developing protective antibody 2 months after completion of 2-dose vaccination. j) Human Papilloma Virus Vaccine There is evidence that infections with higher risk human papillomavirus (HPV) sub-types are more common in HIV infected girls aged 13-19 years than in HIV non-infected girls of the same age. The rates of squamous intraepithelial 120, Level 2 lesions were significantly higher in the HIV infected girls. The HPV vaccine is indicated in girls and women 9 to 26 years of age for the prevention of cervical cancer, precancerous or dysplastic lesions, and genital warts caused by HPV Types 6, 11, 16, and 18. No recommendations have been made regarding the use of HPV vaccinations in HIV-positive individuals. Clinical trials are currently underway to assess the safety and efficacy of the vaccine in individuals with HIV. It should be noted that the candidate vaccines are preventive rather than therapeutic, the benefits of the vaccine in individuals who have already been exposed to HPV are doubtful. 121, Level 2 14 2 doses, 2 months apart
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Appendix 6 MANAGEMENT OF HIV INFECT
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Appendix 7 MANAGEMENT OF HIV INFECT
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3.30 MB - Academy of Medicine of Malaysia

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