Measles, mumps and rubella viruses cause a variety of febrile presentations, including conjunctivitis, coryza, maculopapular rash (measles, rubella) and salivary gland swelling (mumps). In HIV-infected patients, measles is associated with a higher mortality, with delayed and atypical presentations (32). The MMR vaccine contains live attenuated virus and is highly immunogenic in healthy subjects, with measles IgG antibodies developing in 90% of individuals after the first dose and 99% after two doses (33). Side effects include fever and rash in up to 15% of recipients.

The MMR vaccine is contraindicated in immunocompromised people as well as in pregnancy, and should not be administered to HIV patients with a CD4+ T cell count of <200/mL. For measles virus nonimmune HIV patients with a CD4+ T cell count of >200/mL, one or two doses of MMR vaccine are recommended depending on the number of doses received previously. Doses should be administered at least 1 month apart. As is the case with other vaccines, MMR vaccine responses in HIV-infected patients are reduced (34), and immune reconstitution following ART appears to increase rates of measles IgG antibody seropositivity post vaccination (35). Deferring vaccination until patients are established on ART should be considered in cases where the likelihood of exposure to measles is low. The MMRV vaccine is not recommended due to the higher doses of attenuated mumps virus used.