Department of Internal Medicine I, Bonn University Hospital, Venusberg-Campus 1, 53127, Bonn, Germany.
German Centre for Infection Research (DZIF), Partner-site, Cologne-Bonn, Germany.
Infection. 2022 Dec;50(6):1491-1497. doi: 10.1007/s15010-022-01827-6. Epub 2022 May 6.
With modern combination antiretroviral Treatment (cART) a normal life expectancy among people living with HIV (PLWH) has become reality if started early enough prior to the onset of more pronounced immunodeficiency. Therefore, prevention measures against other infectious diseases among this vulnerable group have gained increased attention. Indeed, the EACS guidelines recommend vaccinations against HAV, HBV, HPV, Influenza, Neisseria meningitidis, Streptococcus pneumoniae and VZV in HIV-infected adults.
All PLWH under cART attending our ID outpatient clinic between April to June 2018, were assessed during consultation for vaccination status regarding pneumococcus, Hepatitis A and B, influenza, varicella, meningococcus and HPV using a pre-defined questionnaire, vaccination certificates and medical records. In addition, the cohort database was screened for Hepatitis A and B serology and HIV surrogate markers.
A total of 305 PLWH (82.3% male, 17.7% female) was included, median age was 48 years (IQR 47-51). Median CD4 + T cell count was 543 (IQR 304-770), and for 297 (97.4%) PLWH CD4 + T cell count was ≥ 200/ul. The viral load was undetectable (< 40 copies/ml) in 289 (94.8%) cases. Highest vaccination rates were observed for HAV (87.4%), Streptococcus pneumoniae (77.4%) and Influenza (76.5%). 64.3% PLWH got vaccinated against HBV, whereas VZV vaccination only played a minor role, in the context of the high rate of cleared infections (99.0%). Lowest vaccination rates were detected for HPV (0%) and Neisseria meningitidis (3.0%).
Our data suggest that vaccination rates among PLWH are higher compared to the general German population. Implementation of EACS guidelines into daily routine though is not fully executed and the need for improving vaccination rates has to be emphasized. Centrally organized vaccination registers as well as electronic medical records could be helpful tools to detect a lack of vaccination coverage and send digital vaccination reminders particularly among risk groups.
随着现代联合抗逆转录病毒治疗（cART）的出现，如果在免疫缺陷更为明显之前尽早开始治疗，艾滋病毒感染者（PLWH）的预期寿命可以恢复正常。因此，人们越来越关注这一弱势群体中针对其他传染病的预防措施。事实上，EACS 指南建议对感染 HIV 的成年人进行甲型肝炎、乙型肝炎、HPV、流感、脑膜炎奈瑟菌、肺炎链球菌和水痘带状疱疹病毒的疫苗接种。
2018 年 4 月至 6 月期间，我们 ID 门诊的所有接受 cART 治疗的 PLWH 都在就诊期间通过预定义的问卷、疫苗接种证书和病历，针对肺炎球菌、甲型肝炎和乙型肝炎、流感、水痘、脑膜炎球菌和 HPV 疫苗接种情况进行评估。此外，还对队列数据库进行了甲型肝炎和乙型肝炎血清学和 HIV 替代标志物的筛查。
共纳入 305 名 PLWH（82.3%为男性，17.7%为女性），中位年龄为 48 岁（IQR 47-51）。中位 CD4+T 细胞计数为 543（IQR 304-770），297 名（97.4%）PLWH 的 CD4+T 细胞计数≥200/μl。289 例（94.8%）病毒载量低于检测下限（<40 拷贝/ml）。甲型肝炎（87.4%）、肺炎链球菌（77.4%）和流感（76.5%）的疫苗接种率最高。64.3%的 PLWH 接种了乙型肝炎疫苗，而水痘带状疱疹病毒疫苗接种率则较低（0%），这与高清除感染率（99.0%）有关。HPV（0%）和脑膜炎奈瑟菌（3.0%）的疫苗接种率最低。
我们的数据表明，PLWH 的疫苗接种率高于德国普通人群。尽管 EACS 指南已在日常实践中得到执行，但仍需强调提高疫苗接种率的必要性。集中组织的疫苗接种登记册和电子病历可以作为有用的工具，用于发现疫苗接种覆盖率不足的情况，并向特别是高危人群发送数字疫苗接种提醒。
