Neisseria meningitidis causes meningitis and bacteraemia, with a 5-24 fold increased risk for meningococcal disease among HIV-infected persons across multiple settings associated with a higher mortality (36). Currently in Australia there are increased notifications of disease caused by meningococcal serogroups W and Y across a wide range of age groups. To date there is no data suggesting the risk is increased in patients with HIV infection.

Currently available vaccines include the conjugate MenC and Men ACWY (quadrivalent) vaccines as well as the recombinant MenB vaccine. All vaccines are immunogenic and induce serogroup specific antibody responses. There appears to be a suboptimal response to a single dose of quadrivalent conjugate meningococcal vaccines in HIV-infected adolescents compared with healthy controls (37) and to conjugate meningococcal C vaccine (38). Low CD4+ T cell count and non-suppressed HIV viral load have been reported as predictors of a poorer response (38). No clinical data in HIV-infected individuals are available for MenB vaccine immunogenicity. Therefore, it is recommended that 2 doses of both MenACWY and MenB be administered 8 weeks apart to adults with HIV infection.