加拿大国家免疫咨询委员会（NACI）关于在HIV感染者中使用减毒活流感疫苗（LAIV）的系统评价及建议摘要。

Summary of the NACI systematic review and recommendation on the use of live attenuated influenza vaccine (LAIV) in HIV-infected individuals.

作者信息

Moore Dorothy, Gemmill Ian, Harrison Robyn

机构信息

NACI Influenza Working Group Member.

McGill University, Montréal, QC.

出版信息

Can Commun Dis Rep. 2020 Sep 3;46(9):299-304. doi: 10.14745/ccdr.v46i09a08.

DOI:10.14745/ccdr.v46i09a08

PMID:33104088

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7556201/

Abstract

BACKGROUND

Annual influenza vaccination is recommended for all individuals six months of age and older, including those with HIV infection. Prior to this statement, the National Advisory Committee on Immunization (NACI) stated that live attenuated influenza vaccine (LAIV) was contraindicated for all individuals with HIV infection. The objective of this article is to update NACI's guidance on the use of LAIV for HIV-infected individuals.

METHODS

A systematic literature review of the use of LAIV in individuals with HIV was undertaken. The Canadian Adverse Events Following Immunization Surveillance System was searched for reports of adverse events following vaccination with LAIV in HIV-infected individuals. NACI approved the revised recommendations.

RESULTS

NACI concluded that LAIV is immunogenic in children with HIV, and available data suggest that it is safe, although data were insufficient to detect possible uncommon adverse effects. LAIV may be considered as an option for vaccination of children 2-17 years old who meet the following criteria: 1) receiving highly active antiretroviral therapy for at least four months; 2) CD4 count of 500/µL or greater if age 2-5 years, or of 200/µL or greater if age 6-17 years; and 3) HIV plasma RNA less than 10,000 copies/mL. LAIV remains contraindicated for adults with HIV because of insufficient data. Intramuscular influenza vaccination is considered the standard for children living with HIV by NACI and the Canadian Paediatric & Perinatal HIV/AIDS Research Group, particularly for those without HIV viral load suppression (i.e. plasma HIV RNA is 40 copies/mL or greater). However, if intramuscular (IM) vaccination is not accepted by the patient or substitute decision-maker, LAIV would be reasonable for children meeting the criteria listed above.

CONCLUSION

LAIV may be considered as an option for annual vaccination of selected children with HIV.

摘要

背景

建议所有6个月及以上的个体每年接种流感疫苗，包括艾滋病毒感染者。在此声明之前，国家免疫咨询委员会（NACI）指出，减毒活流感疫苗（LAIV）对所有艾滋病毒感染者均为禁忌。本文的目的是更新NACI关于艾滋病毒感染者使用LAIV的指导意见。

方法

对艾滋病毒感染者使用LAIV进行了系统的文献综述。检索了加拿大免疫接种后不良事件监测系统，以查找艾滋病毒感染者接种LAIV后不良事件的报告。NACI批准了修订后的建议。

结果

NACI得出结论，LAIV在艾滋病毒感染儿童中具有免疫原性，现有数据表明它是安全的，尽管数据不足以检测可能的罕见不良反应。对于符合以下标准的2至17岁儿童，可考虑将LAIV作为疫苗接种的一种选择：1）接受高效抗逆转录病毒治疗至少四个月；2）2至5岁时CD4细胞计数为500/µL或更高，6至17岁时为200/µL或更高；3）艾滋病毒血浆RNA低于10,000拷贝/mL。由于数据不足，LAIV对艾滋病毒感染成人仍为禁忌。NACI和加拿大儿科学与围产期艾滋病毒/艾滋病研究组认为，肌肉注射流感疫苗是艾滋病毒感染儿童的标准接种方式，特别是对于那些未实现艾滋病毒病毒载量抑制（即血浆艾滋病毒RNA为40拷贝/mL或更高）的儿童。然而，如果患者或替代决策者不接受肌肉注射（IM）疫苗接种，对于符合上述标准的儿童，LAIV是合理的选择。