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Vaacinations vs CD4 count
Dec 19, 2009

A disparage of opinion has occurred in relation to the effectiveness of giving an HIV+ patient vaccinations with low CD4 counts. Some say hold under 200 or 100 count, others state give it any time. What evidence is out there to support any of the above thinking?

Response from Dr. Frascino

Hi,

Yes, there is evidence for both points of view! The reason is that with low CD4 counts and a severely deficient immune system, it is possible that a vaccination might not engender the desired result of inducing protective antibodies against a particular germ. However, this varies considerably from person to person and among different immunizations (vaccinations). Generally speaking, most HIV physician specialists are well versed in when and why to vaccinate or withhold vaccination. For instance, if someone is reasonably healthy and newly diagnosed, but has a very low CD4 count, it may well be reasonable to begin treatment with combination antiretroviral therapy plus appropriate opportunistic infection prophylaxis and wait to see if there will be a prompt and significant immune restoration response (rise in CD4 count). If so, waiting to give routine, non-urgent vaccinations would make sense. If, on the other hand, someone is chronically infected and despite best efforts with aggressive antiretroviral therapies, the CD4 count remains low, vaccination should be tried. Some vaccinations may work well (induce the appropriate protective response) even with low CD4 counts. Efficacy of vaccinations can be checked by monitoring the level of vaccine-induced antibody response.

Dr. Bob



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