Ask the HIV Specialist, from the September/October issue of Positively Aware Options

[Root Admin]

This column is from the September/October 2008 issue of Positively Aware

Dear HIV Specialist:

What does a person who is HIV-positive and taking HIV meds need to know about the risks of getting a vaccine for meningococcal disease?

Signed, Vaccine Vexed

Dear VV:

Although initially there was concern that HIV infection might make a person more susceptible to meningococcal disease, studies have not supported this theory. Therefore, current CDC and DHHS immunization guidelines recommend this vaccination for adolescents and adults with HIV infection only if they fall into the usual meningococcal disease risk categories (http://www.immunize.org/catg.d/p2011.pdf; http://aidsinfo.nih.gov/contentfiles/Adult_OI.pdf). There is no known interaction with HIV drugs.

Meningococcal disease, including meningitis (infection in the tissues and fluid associated with the brain and spinal cord) and meningococcemia (infection in the blood) is caused by the bacteria Neisseria meningitidis. Although these organisms live in the throat and respiratory tract of up to one in three people, relatively few people in the U.S. actually develop meningococcal disease (about 1:100,000).

There are two different types of vaccines for meningococcus: MPSV4 (meningococcal polysaccharide vaccine, Menomune) and MCV4 (meningococcal conjugate vaccine, MenactraT).

Overall, meningococcal vaccine is well tolerated. Risks include mild reactions such as pain and redness at the injection site (which occur in up to 50% of those vaccinated) and transient fever (which occurs in up to 5%). Although severe allergic reactions are rare, they can be life-threatening. Therefore, the vaccine should not be given to anyone who has had a prior anaphylactic reaction to any vaccine component.

People receiving MCV4 vaccine may have a slightly increased risk of developing Guillain-Barre syndrome (GBS), a serious neurologic disorder. However, it has been difficult to determine if an actual link exists, because the number of cases has been small and the rate of occurrence of GBS in those receiving the vaccination has been about the same as the natural rate. Currently, it is recommended that MCV4 be used cautiously in persons who have a prior history of GBS. The MPSV4 vaccine has not been associated with GBS.

I recommend that you look at the links above and talk to your healthcare provider about whether the potential benefits of vaccination outweigh the risks and if this vaccine is right for you.

Kay Kalousek, DO, MS, AAHIVS, FACOFP
Assistant Dean, Medical Education
Western University of Health Sciences
College of Osteopathic Medicine of the Pacific