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Author20 Posts
  #1

You are the physician taking care of a 38y old male patient who has tested positive for HIV. Currently asymptomatic cd4 500/uL viral load 4000. Asking about MMR status last vaccination given at age 15. What do you tell him:

1. MMR is not advisable for HIV patients as it is a live vaccine.
2. MMR not required for Pt. with HIV. 3. LEt me give you the vaccine.
4. HIV pt. respond poorly to MMR.
5 MMR only recommended for children.





Edited by Data297 on Dec 03, 2006 - 1:53 PM

  #2

well coming to your query directly
i will vote for option number 5.just because these are childhood respiratory diseases..secondly i never read about these three diseases being common in HIV patients..

what is the answer?


  #3

1.


  #4

I go with choice 3.

CD4 is over 500 so we can give vaccine.


  #5

yope even 1 could be the answer live vaccines are contraindicated in:-
pregnancy
immunosuppressed patients
corticosteroid therapy
etcetera
i am getting only this much at the moment ...


  #6

but the answer here is 3 cos the patient may have serious complications due to lack of vaccination as patients CD4 fall below 200. So its the right time to give the vaccine as he is very less likely to develop infection right now.. thats what UW says!sticking out tongue


  #7

see the options are very close in the above question...but still i vote for (5)..buddies have you evere read HIV patient contracting measles,mumps or rubella..i may be wrong..but i want an authentic answer..


  #8

ill go with 1 ... i guess you're right in some way dipsite abput the odds of the viruses on a HIV patient .. but neverthlss you are introducing live attenuated viruses on a inmunosupressed patient .. so .. i just go with 1 confused


  #9

MMR is the only live vaccine indicated in HIV! This is bcos, the effects of natural infection in this setting is very severe. But here it says that he's already immunised at age 15...so I feel there is no neccesity now.


  #10

Had problems with this question
According to usmleworld the answer is 3. Let me give you the vaccine...



  #11

i was wrong .. the answer is 3
why? because according to kaplan books an HIV patient could receive any live vaccine if asymptomatic. it has nothing to do with cd4 nor viral load .. is the symptoms. since the pt is asympt .. give him the vaccine.


  #12

From cdc.gov guidelines:
HIV patients should receive - MMR ( no if CD4< 200), HBV, Influenza ( not nasal) , S pneumoniae, Td.


  #13

3. LEt me give you the vaccine BIG TIME


  #14

MMR vaccine at--> 12-15ms(1st dose), & at 4-6yrs (2nd dose)

I never heared that it is recommended for adults especially if immune compromized(absolute contraindication in children so i guess its still contraindicated in immune compromized adults) so i'll go with 5



  #15

doc_clotaire wrote:
3. LEt me give you the vaccine BIG TIME


Agree!! they use to say no live vaccines... but now its based on the T4 count greater then 200 I believe?
good trick question.



  #16

Any idea on why we have to RE-VACCINATE this patient if he already had it? Don't we develop life-long immunity with the MMR vaccine? confused


  #17

sorry guys, I got wrong, the ans is 3. this is the CDC recommend for HIV vacc

just follow this link for the recommended vacc

www.cdc.gov/mmwr/preview/mm.../00025228.htm#00000396.htm



Edited by cirus on Jul 07, 2007 - 12:40 PM

  #18

I had this question the other day from UW also and the answer is 3. Let me give you the vaccine.

The reason is that MMR is a live vaccine, and you usually do NOT give live vaccines to immunocompromised individuals, BUT you SHOULD give the MMR to HIV+ patients who are ASYMPTOMATIC and NOT SEVERELY IMMUNOCOMPROMISED.
This guy had a high T-cell count and a low viral load, so it is ok to give him the vaccine... He would be more in danger NOT getting the vaccine and getting Measels versus risks from getting the vaccine.

My follow up question on this is WHAT IS THE CUT-OFF for T-Cell Count and Viral Load to determine if someone is or isn't immuncompromised? (Is it the same as When to start therapy: T-Cells under 350 and Viral Load under 55,000??)





  #19

well kaplan 2008-09 says tcell<350 OR viral load>55000
its probably worth remembering its OR not AND


  #20

3...let me give u the vaccine as patients CD 4 count is pretty high....





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