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Yellow Fever Vaccination and Being HIV+
Jun 9, 2010

I am traveling to Togo and Benin in about three months. These countries require the Yellow Fever Vaccination. I understand that HIV+ individuals are discouraged from receiving the vaccine. However, recently I have read more and more that if one's CD4/T-Cell count is 500 or above and he or she does not have a Viral Load, it is safe to proceed with the vaccination. So, I contacted a "travel nurse" who administers the vaccination earlier today in my area, and she seemed to feel that I would be ok, especially since I informed her that I had already received the vaccine back somewhere between 1993-1995, and did not experience any difficulties with it. This nurse, who took nearly 30 minutes talking to me, (impressive) explained it to me in very "laymens" terms. She said, more or less, "since you have alredy had the vaccine, your body already has some sort of an immunity to it, so you should not have any problems with receiving the vaccine. You will be waking up your army to the virus, it is just a booster for you." I then explained to her that I usually have anywhere between 550-800 T-Cells and an undetectable viral load. She didn't seem to feel that I would experience any problems.

Should I be in the "safe-zone" in receiving the vaccination. I highly doubt that I am the first person in this health group who has been in need of the vaccination.

I am writing this question to see what one of the experts thinks??????

Response from Dr. Young

Hello and thanks for your post.

I asked my friend and colleague, Dr. John Hammer from Global Travel Health and

Rocky Mountain CARES in Denver to answer your question.

He says: "It sounds like you came upon a good travel nurse (with reasonable advice). The generally accepted (though not thoroughly studied) CD4 cutoff for those with HIV and well controlled viremia on therapy is 200 (those above this level can likely receive the vaccine safely). The main concern for the elderly or immunocompromised individuals across the board revolves around the risk for an actual vaccine infection which results in liver failure and possible death. This phenomena has been described in one HIV-infected individual who was found to have HIV (and a CD4 count of 108) after his vaccination and during the course of his illness (a very unfortunate occurrence). Since then, many HIV-infected persons on suppressive therapy and with counts > 200 have been vaccinated without reported incident. As for your prior vaccination, this should indeed give added reassurance as there has never been a case of vaccine-associated disease in a person receiving a second (or beyond) vaccination. So it should be safe to try to "wake up your army' and have safer, and hopefully happier, travels. BTW - please remember to get advice/recommendations/medications to prevent or treat other more common diseases endemic to your destinations such as malaria and travelers' diarrhea. I'm sure that your travel nurse can help you out there as well."

At what point should I start HIV medication?
which is better medicine

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