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Jul 21, 2002

Dear Dr. Young: Forgive me if this is not the appropriate forum for this question, but I did not know who to ask. I am a healthcare professional working in the ICU of a large hospita. I have been HIV+ for 3 or 4 years. Never been ill, never been on antiretrovirals. If it became necessary to be innoculated against smallpox, would you recommend this in an HIV + person? If so, would the stage of the HIV infection be taken into consideration? That is Cd4 levels and viral load? My Cd4 has been stable at 500, and my viral load 40K (PCR). Thank you very much for your help. You all do fantastic jobs at these forums!

Response from Dr. Young

Thanks for your questions and warm comments.

Hopefully, this the issue of smallpox vaccinations won't become a significant one in the near-term future (though some have suggested that certain key health care workers may be first to be vaccinated, aside from military).

Currently, I'm very conservative and not vaccinating any of my patients with live-virus products-- the risk of serious complications would seem to be higher among the immunosuppressed. This is certainly the case for mumps, measles, rubella and yellow fever vaccinations.

If push came to shove, with a stable and normal CD4 cell level, I'd imagine (without good data) that the actual risk of complication from so-called contraindicated vaccine products would have to be very low, and approximately that of non-HIV-infected persons.

I'm not sure if this provides a concrete answer, since there really isn't one to be had, but hope that you find this helpful. -BY

STI advice
Medrol before HAART

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