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Nov 25, 2014

Does the yellow fever injection and malaria immunazation clash with ARVZ? My work comes with alot of travelling so i would like to know if i can take such immunizations while on ARVz and is it safe to do so

Response from Dr. Young

Hello and thanks for posting.

Regarding yellow fever vaccination, if you have asymptomatic HIV illness and CD4 count more than 500, the vaccine can be given without any additional concerns.

The US Centers for Disease Control and Prevention (CDC) gives these cautious recommendations:

"Asymptomatic HIV infection with CD4 T-lymphocyte values 200499/mm3 or 15%24% of total lymphocytes for children aged <6 years is a precaution for yellow fever vaccination (see also the discussion of HIV infection in the Contraindications section above). Large prospective, randomized trials have not been performed to adequately address the safety and efficacy of yellow fever vaccine among this group. Several retrospective and prospective studies including >500 people infected with HIV have reported no serious adverse events among patients considered moderately immunosuppressed based on their CD4 counts. However, HIV infection has been associated with a reduced immunologic response to a number of inactivated and live attenuated vaccines, including yellow fever vaccine. The mechanisms for the diminished immune response in HIV-infected people are uncertain but appear to be correlated with HIV RNA levels and CD4 T-cell counts.

Because vaccinating asymptomatic HIV-infected people might be less effective than vaccinating people not infected with HIV, measuring their neutralizing antibody response to vaccination should be considered before travel. Contact the state health department or the CDC Arboviral Diseases Branch (970-221-6400) to discuss serologic testing.

If an asymptomatic HIV-infected person with moderate immune suppression (CD4 T-lymphocyte values 200499/mm3 or 15%24% of total lymphocytes for children aged <6 years) is traveling to a yellow feverendemic area, vaccination may be considered. Vaccinated people should be monitored closely after vaccination for evidence of adverse events, and the state health department or CDC should be notified if an adverse event occurs. However, if international travel requirementsnot risk of yellow feverare the only reason to vaccinate an HIV-infected person, the person should be excused from immunization and issued a medical waiver to fulfill health regulations.

If an asymptomatic HIV-infected person has no evidence of immune suppression based on CD4 counts (CD4 T-lymphocyte values ≥500/mm3 or ≥25% of total lymphocytes for children aged <6 years), yellow fever vaccine can be administered if recommended."

Malaria prevention involves antibiotics, not an immunization. Usually malaria prevention meds don't interact with HIV medications, but this depends on the specifics on both malaria and HIV medications.

Hope that helps, and safe travels, BY

Kivexa and efavirenz

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