Update 2: Patients Infected With HIV
The new guidelines also expand recommendations for patients with human immunodeficiency virus (HIV) and remove language distinguishing asymptomatic from symptomatic patients. Vaccination is now recommended for all patients aged 12 months or older who do not have evidence of immunity and are not severely immunosuppressed (CD4 ≥15% for at least 6 months in patients aged 5 years or younger; CD4 percentages ≥15% and CD4 count ≥200 lymphocytes/mm for at least 6 months in patients older than 5 years). After the patient has been established on effective antiretroviral therapy (ART), he or she should receive two doses of vaccine separated by at least 28 days to reestablish immunity to measles, mumps, and rubella.
Young patients infected with HIV are now started on ART early, including within the first year of life. Because MMR vaccination in patients on effective ART has been shown to provide immunity, the recommendations for timing of the two MMR vaccine doses for HIV patients have been changed to mirror those for non-HIV patients. The first dose should be administered at 12–15 months of age, and the second dose should be administered at 4–6 years of age, before entering school.