Implications of the Human Immunodeficiency Virus Epidemic for Control and Eradication of Measles

Human immunodeficiency virus (HIV)—infected persons may be important, unrecognized transmitters of measles virus, thwarting eradication efforts. We reviewed the published English-language literature on measles and measles immunization in HIV-infected persons to investigate the clinical features of measles, the responses to measles immunization, and the safety of measles vaccine in HIV-infected persons and, conversely, the effect of measles and measles immunization on HIV infection. HIV-infected persons with measles are likely to have uncharacteristic clinical findings and severe illness, with high rates of pneumonitis and death. Primary and secondary failure of measles vaccine in HIV-infected children may permit transmission of measles virus in spite of high rates of immunization coverage. A factor that complicates measles-control efforts in areas of high prevalence of HIV is the potential for fatal infection with measles vaccine virus. Further research on the impact of the HIV epidemic on measles and measles immunization is necessary to guide strategies for the eradication of measles.