Vaccination as a means of disease prevention in HIV infected individuals; successes, challenges & opportunities

Abstract

This thesis is structured to systemically assess susceptibility to vaccine preventable infections in HIV-infected adults, to investigate effectiveness of an integrated vaccine programme as a model of care for vaccine delivery to a HIV-infected cohort, to investigate the burden of vaccine preventable infections (pneumococcal and human papillomavirus (HPV) infection) in HIV-infected adults and to assess immunognenicity of a prime-boost pneumococcal vaccine strategy and HPV vaccine in HIV-infected adults.

Chapter 2 investigates seroepidemiology of common vaccine preventable infections (hepatitis A virus (HAV), hepatitis B virus (HBV), varicella zoster virus (VZV), measles, mumps and rubella (MMR) in HIV-infected adults attending the department of Genito Urinary Medicine and Infectious Diseases clinic (GUIDE), the largest tertiary referral HIV specialist centre in Ireland.

Chapter 3 investigates the effectiveness of an integrated vaccine unit as a model of care for delivery of routine immunisations including seasonal influenza vaccine, pneumococcal vaccine and HBV vaccine to a cohort of HIV-infected adults.

Chapter 4 examines the burden of invasive pneumococcal disease (IPD) in HIV-infected adults attending a tertiary referral hospital (St James?s Hospital, Dublin). We then investigate immunogenicity of pneumococcal vaccine strategies in HIV-infected adults.

Chapter 5 examines the burden of anal cancer in HIV-infected adults attending the GUIDE clinic. Additionally, we investigate prevalence and persistence of HPV infection and infection with high-risk (hr) or oncogenic HPV types in HIV-infected MSM. We examine acceptability of HPV vaccine in this patient group and immunogenicity of the quadrivalent HPV vaccine in young HIV-infected MSM in whom the HPV vaccine is indicated.

Chapter 6 extends the context surrounding the research questions, discusses the main findings of the PhD, draws conclusions and alludes to future directions of research to build on findings of this thesis.