[Vaccinations of HIV-infected travelers]

Human immunodeficiency virus (HIV) positive international travelers are at higher risk of infectious complications. The pretravel assessment often provides an opportunity to update routine vaccinations and HIV patient specific vaccinations including pneumococcus, hepatitis A, hepatitis B, and influenza. Other vaccinations may be required or recommended. Decision for vaccination require considering the risk and severity of the vaccine, preventable diseases in the destination area, the nature of the vaccine (live attenuated vaccines or not), the patient's immune status, and the risk of virological rebound as a consequence of vaccination. The immunogenicity of vaccines is decreased in HIV patient with low CD4 cell counts (above 500 cells per cubic millimetres and particularly above 200 cells per cubic millimetres) and in patients with a persistent HIV RNA viral load. Vaccines should be administered to patients whose HIV infections are in the early stage or in patients receiving HAART with a satisfactory immune status and reduced HIV RNA level. Testing of postvaccination antibodies is useful if serological protective levels are defined. In case of non-response after vaccination, few studies suggest that additional revaccination, increase of vaccine dose, intradermic vaccination, or use of prime-boost combination may be successful. Further research is needed to define vaccination strategies, adapted to the immune status of the HIV patient.