Dr. Ira Shah
M.D, DNB, DCH(Gold Medalist), FCPS

Children with HIV are immunosuppressed and prone to get infections frequently. Also vaccines may not have a good uptake due to poor antibody response. Also there is always a risk of giving a live vaccine in an immunosuppressed child as it may lead to reactivation.

Thus, regarding immunization of an HIV infected child, the following points should be kept in mind:

• In general, children with advances HIV disease and low CD4 count should not receive live vaccines, either viral or bacterial, because of the risk of disease from the vaccine strains.
• Immune response to inactivated vaccines ((e.g., DTP, hepatitis B, hepatitis A, inactivated poliovirus, Hib, pneumococcal, and influenza)) may be inadequate. Hence more booster shots may be required. It may also be prudent to check for seroconversion and titres at the end of vaccination to check for efficacy whenever possible
• Children should receive IPV instead of OPV if available
• BCG may be given in endemic areas at birth. However it should be avoided in non endemic areas in children with advanced disease.
• Measles and MMR should only be given when CD4 count is in the normal range.
• Other routine vaccines should be given as per recommendations of the country for the immunization schedule.