• New York State Department of Health. Immunologic considerations in HIV-infected children. New York (NY): New York State Department of Health; 2003 Mar. 20 p. [5 references]

This is the current release of the guideline.

Antiretroviral Therapy and The Immune System

For specific clinical recommendations, the clinician should refer to Chapter 4: Pediatric Antiretroviral Therapy.

Immunization of Human Immunodeficiency Virus (HIV)-Infected Children

Immunizations to prevent infections should be used when available and safe (see Table 1 below and in the original guideline document).

Immunologic Laboratory Evaluation of HIV-Infected Children

A baseline evaluation should be completed and should include quantitative assessment of the cellular immune system, including lymphocyte immunophenotyping, to determine absolute numbers and percentages of CD4 and CD8 T lymphocyte subsets.

Lymphocyte subsets should be obtained at baseline (preferably in replicate), and 1 to 2 months after initiation of a new antiretroviral (ARV) regimen as a measure of response to treatment. They should subsequently be repeated every 3 to 4 months to make sure immune function is being maintained, or more frequently in children with clinical deterioration or rapid decline in CD4 count.

Table 1: Routine Immunization for HIV-Infected Children

Vaccine: Use and Precautions

• Hepatitis B: YES
• Diphtheria, tetanus, acellular pertussis: YES
• Inactivated polio: YES; do not use oral polio vaccine; inactivated vaccine for household contacts
• Measles, mumps, rubella: YES except in severely immunocompromised children [i.e., children in CD4 Immunologic Category 3 (see Table 2 below)]
• Haemophilus influenzae type B: YES
• Hepatitis A: CONSIDER, especially in children with hepatitis B and C and other liver dysfunction, and in travelers
• Pneumococcal, polysaccharide, and conjugate: YES
• Influenza: YES
• Varicella: YES, ONLY to children who are asymptomatic and in CD4 Immunologic Category 1 (see Table 2 below); OFFER to uninfected, nonimmune household contacts

Table 2. Immunologic Categories for HIV-Infected Children Based on Age-Specific CD4 T-Lymphocyte Counts and Percentage of Total Lymphocytes

Immunologic category

No evidence of suppression

Age and cells/mm³ (%)*

• <12 months: ≥1,500 (>25)
• 1-5 years: ≥1,000 (>25)
• 6-12 years: ≥500 (>25)

Evidence of moderate suppression

Age and cells/mm³ (%)*

• <12 months: 750-1,499 (15-24)
• 1-5 years: 500-999 (15-24)
• 6-12 years: 200-499 (15-24)

Severe suppression

Age and cells/mm³ (%)*

• <12 months: <750 (<15)
• 1-5 years: <500 (<15)
• 6-12 years: <200 (<15)

* Percentage of total lymphocytes.

None provided

The type of evidence supporting the recommendations is not stated.

• New York State Department of Health. Immunologic considerations in HIV-infected children. New York (NY): New York State Department of Health; 2003 Mar. 20 p. [5 references]

Not applicable: The guideline was not adapted from another source.

2003 Mar

New York State Department of Health - State/Local Government Agency [U.S.]

New York State Department of Health

Committee for the Care of Children and Adolescents with HIV Infection

Committee Chair: Joseph S. Cervia, MD, Director, The Comprehensive HIV Care and Research Center, Long Island Jewish Medical Center

Committee Vice Chair: Jeffrey M. Birnbaum, MD, MPH, Director, HEAT Program, Kings County Hospital

Committee Members: Elaine Abrams, MD, Director, Family Care Center, Department of Pediatrics, Harlem Hospital Center; Saroj Bakshi, MD, Chief, Division of Pediatric Infectious Diseases, Bronx-Lebanon Hospital Center; Howard J. Balbi, MD, Director, Pediatric Infectious Diseases and Pediatric AIDS Program, Nassau County Medical Center; Coleen K. Cunningham, MD, Associate Professor of Pediatrics, SUNY Upstate Medical University; Samuel Grubman, MD, Chief, Allergy and Immunology, Saint Vincents Catholic Medical Centers, St. Vincent's Manhattan; Sharon Nachman, MD, Chief, Pediatric Infectious Diseases, Associate Professor of Pediatrics, SUNY at Stony Brook. Department of Pediatrics; Catherine J. Painter, MD, PhD, Assistant Professor of Clinical Pediatrics, College of Physicians and Surgeons, Columbia University, Medical Director, Incarnation Children's Center; Vicki Peters, MD, Coordinator, Pediatric HIV Special Projects, Office of AIDS Surveillance, New York City Department of Health; Roberto Posada, MD, Assistant Professor of Pediatrics, Division of Pediatric Infectious Diseases, Director, Pediatric HIV Program, Mount Sinai School of Medicine; Barbara Warren, BSN, MPH, PNP, Assistant Bureau Director, Bureau of HIV Ambulatory Care Services, AIDS Institute, New York State Department of Health; Geoffrey A. Weinberg, MD, Director, Pediatric HIV Program, Associate Professor of Pediatrics, Department of Pediatrics, University of Rochester School of Medicine and Dentistry; Ed Handelsman, MD, Assistant Professor of Pediatrics, SUNY Health Sciences Center at Downstate, Assistant Medical Director of Pediatrics, Office of the Medical Director, AIDS Institute

Not stated

This is the current release of the guideline.

None available

This summary was prepared by ECRI on January 21, 2004.