Vaccines play an important role in protecting older adults with HIV from serious illnesses caused by bacteria and viruses. The use of vaccines protects individuals and the public health of the community. However, even if HIV is well managed, older adults with HIV have characteristics that require special attention. Age and the lasting effects of HIV can compromise immune function. Vaccines and other strategies can help protect your health. These include the use of higher or multiple doses of vaccines.

Vaccines work by generating antibodies that can attack certain bacteria or viruses. There are two types of vaccines. One is called “inactivated” vaccine and can be used no matter what levels of immunosuppression exists, as indicated by a low CD4. Inactivated vaccines use bacteria or viruses that have all been killed. Common vaccines of this class are tetanus and influenza. The second type is “live-attenuated organism”. These vaccines may still have some weakened bacteria or virus present. For healthy adults, live-attenuated vaccines do not pose a health risk. But those vaccines could cause problems in older adults with HIV who have CD4 counts less than 200. Live-attenuated vaccines include those that protect against mumps and measles.

What you should know and do

Because of the complexities of different types of vaccines, you should discuss the vaccines you may need with your healthcare provider. Unfortunately, the FDA (Food and Drug Administration), which sets the standards for immunizations, has not provided specific guidance for older adults with HIV. You should follow the general recommendations for your age group. An example is the vaccination for herpes zoster (shingles). A new vaccine that is not a “live” vaccine is indicated for all people 50 years and older. Tested in older adults with HIV have found the shingles vaccines to be effective with a perhaps greater protective effect in those with a higher CD4 count. For the seasonal influenza vaccine, the FDA has approved a new stronger product that can increase the antibody response and may be more protective for people with HIV. However, this vaccine is only approved for people older than 65 years of age and not for younger people with HIV. You should consult with your physician about whether this vaccine is right for you. Finally, with recent measles outbreaks in the United States, you may wonder whether you should get the vaccine. Most older adults with HIV probably have had measles as youngsters. But if you are not sure, then your doctor may recommend the combination mumps, measles and rubella vaccine that can be used if your CD4 count is greater than 200.