Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa.
Hum Vaccin Immunother. 2019;15(11):2578-2589. doi: 10.1080/21645515.2019.1599677. Epub 2019 May 22.
Evidence-based approaches were used in making recommendations for vaccination against vaccine-preventable diseases for HIV-infected and HIV-exposed individuals but with limited substantiation. We conducted a systematic review and meta-analysis with randomized-controlled trials (RCTs), cohort and case-control studies that have efficacy and effectiveness of vaccines in HIV-infected and HIV-exposed children as outcomes. Web of Science, Cochrane Library, PubMed and Scopus databases were searched for articles. Efficacy of 9-valent pneumococcal conjugate vaccine (PCV9) against total vaccine serotype invasive pneumococcal disease was 32% in HIV-infected children and 78% among HIV-uninfected children. Vaccine effectiveness of Bacillus Calmette-Guérin vaccine in preventing tuberculosis in HIV-infected children was zero compared to 59% protection in HIV-unexposed children. Likewise, HIV-uninfected children have better protection against invasive type b disease than the HIV-infected children. Effectiveness studies of rotavirus vaccines show that HIV-exposed uninfected children have similar protection against rotavirus gastroenteritis compared to the non-exposed children. Children who are severely immunosuppressed are poorly protected against invasive pneumococcal diseases. HIV-infected children tend to have lesser vaccine protection against vaccine-preventable diseases when compared to unexposed children. HIV-infected children who are immunocompetent are more likely to have better vaccine protection against vaccine-preventable diseases than those who are immunosuppressed. The overall quality of the observational studies was very low with very little confidence in the effect estimate. The overall quality of evidence for the RCT outcomes was mainly high. This study reveals a dearth of efficacy and effectiveness studies among HIV-infected and exposed children.
采用循证方法为 HIV 感染者和 HIV 暴露者推荐疫苗接种以预防可通过疫苗预防的疾病，但证据有限。我们进行了一项系统评价和荟萃分析，纳入了以 HIV 感染和 HIV 暴露儿童为结局的疫苗有效性和效果的随机对照试验（RCT）、队列研究和病例对照研究。检索了 Web of Science、Cochrane 图书馆、PubMed 和 Scopus 数据库中的文章。9 价肺炎球菌结合疫苗（PCV9）对 HIV 感染儿童的总疫苗血清型侵袭性肺炎球菌病的疗效为 32%，对 HIV 未感染儿童的疗效为 78%。卡介苗（BCG）疫苗预防 HIV 感染儿童结核病的疫苗效力为零，而对 HIV 未暴露儿童的保护率为 59%。同样，HIV 未感染儿童对侵袭性 b 型疾病的保护也优于 HIV 感染儿童。轮状病毒疫苗的有效性研究表明，与未暴露儿童相比，HIV 暴露未感染儿童对轮状病毒胃肠炎具有相似的保护作用。严重免疫抑制的儿童对侵袭性肺炎球菌病的保护作用较差。与未暴露儿童相比，HIV 感染儿童对疫苗可预防疾病的疫苗保护作用较弱。免疫功能正常的 HIV 感染儿童比免疫抑制儿童更有可能获得更好的疫苗保护，以预防疫苗可预防的疾病。观察性研究的总体质量非常低，对效果估计的信心非常低。RCT 结局的证据总体质量主要为高。这项研究揭示了 HIV 感染和暴露儿童中缺乏疗效和效果研究。
