What are the risks of smallpox vaccine with HIV infection?
A. Progressive vaccinia (or vaccinia necrosum) is the major risk.4 This is one of the most dreaded complications of vaccinia and is seen primarily in patients with compromised cell-mediated immunity such as patients with AIDS, organ transplants, cancer chemotherapy, chronic corticosteroids, hematologic malignancies, and combined immunodeficiency disorders; it has also been seen in some with hypogammaglobulinemia.4 This reaction consists of progressive enlargement of the primary site of inoculation and viremic spread to other sites with new disseminated lesions. The lesions show minimal local inflammation, biopsies confirm minimal lymphocytic infiltrates, and cultures of these distant sites yield vaccinia.4, 12-16 This complication may occur after primary vaccination or revaccination and is usually fatal.4, 14, 16 A possibly typical case has been described in a 19-year-old military recruit not previously known to have HIV infection who had a smallpox vaccination in May 1984.16 This pati
