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Yellow fever vaccination

Sep 17, 2009

I have been HIV+ for 6 years, never been on ARV, VL has consistently been between 50 -400, CD4 never been below 800 CD4% consistently 30%. I want to travel to Amazonia in Brazil and obviously would require a yellow fever vaccination. My HIV specialist refuses to give me the vaccination. A friend who is also a HIV specialist gave me a french study to read which showed in HIV patients with good immune function that a yellow fever vaccination is safe. He suggests I go to a travel doctor and get the jab. In your opinion am I putting myself at unnecesary risk, I don't have to go to Amazonia it's just a trip I've always wanted to make. HIV has had limited impact on my life, and this is the first time I've experienced something that I couldn't so because I am positive. What sort of risk would I be taking if I decided to be vaccinated. Your expertise is much appreciated.

Response from Dr. Young

Hello and thanks for your post.

I've asked my colleague and tropical medicine expert, Dr. John Hammer from the Global Travel Health clinic in Denver to answer.

"This a question that we run into on a fairly regular basis in a busy travel clinic with a number of positive patients.

Yellow fever vaccine can pose a risk to those with immunosuppression due to a number of causes including HIV as the vaccine is a live virus that can cause active and potentially life threatening infections in these populations. However, though there was a single case reported of brain infection with the vaccine virus in an HIV-infected patient, this was a person with previously unrecognized HIV infection and a CD4 count of 108. Subsequent experience has lead to the recommendation from the CDC that positive people on effective treatment with a documented CD4 above 200 who can not avoid exposure to yellow fever on their travels (this sounds like your scenario) can be immunized safely but should be monitored closely for any adverse events following vaccination. Small studies have shown no ill effects from the vaccine on CD4 count or VL as well.

A second question involves your response to the vaccine. With a CD4 count of 800 and a well controlled VL your response should be adequate, but immunocompromised persons may not respond fully to vaccines in general (and not benefit fully from them). As a precaution, your response to the vaccine can be checked with a blood test following your shot (for information on the test your provider can contact the CDC at (303) 221-6400). Remember to ask your provider about protection against more common diseases associated with travel to the Amazon such as malaria, travelers diarrhea and typhoid fever (all easily done) and have a wonderful trip!"

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