Infectious Disease Book


  • Immunization in HIV


Immunization in HIV

Aka: Immunization in HIV, Vaccination in HIV, Immunizations in HIV
  1. See Also
    1. Vaccines in Immunocompromised Patients
    2. Immunization in Pregnancy
    3. Pediatric Vaccination (Primary Series)
    4. Adult Vaccination
  2. Precautions
    1. Do not give Live Vaccines (e.g. oral polio, Varicella Vaccine, Flumist) if CD4 Count <200
    2. Defer non-urgent Vaccinations until after Antiretroviral therapy initiated to boost immune response
  3. Preparations: Live Vaccines
    1. Avoid Live Vaccines in HIV when CD4 Count <200
    2. Specific Live Vaccines to avoid
      1. Herpes Zoster Vaccine (recombinant Herpes Zoster Vaccine is not contraindicated)
      2. Varicella Vaccine
      3. Rotavirus Vaccine
      4. Oral Polio Vaccine
      5. Live Attenuated Influenza Vaccine (e.g. Flumist)
      6. Measles Mumps Rubella Vaccine (MMR Vaccine)
  4. Preparations: Indicated Non-Live Vaccines
    1. Consider delayed Vaccination until CD4 Count>200 and after Antiretroviral therapy initiated
    2. Pneumococcal Vaccine
      1. Prevnar 13 followed by Pneumovax at least 8 weeks later
      2. Give after diagnosis and then every 6 years
      3. Immunogenicity is better if higher CD4 Count >200
    3. Conjugated H Influenza type b capsular Vaccine
      1. Highly immunogenic in HIV without advanced disease
    4. Influenza Vaccine yearly (inactivated form)
    5. Hepatitis A Vaccine (all of those susceptible)
    6. Hepatitis B Vaccine (if HBsAg negative)
    7. Routine Tetanus Vaccine (Tdap or Td)
    8. Human Papilloma Virus Vaccine (Gardasil, consider for those up to age 45 years old)
    9. Meningococcal Vaccine (all patients with HIV)
    10. Consider Hib Vaccine
    11. Recombinant Herpes Zoster Vaccine (Shingrix, for those over age 50 years)
  5. References
    1. GoldSchmidt (2016) Am Fam Physician 94(9): 708-16 [PubMed]
    2. GoldSchmidt (2021) Am Fam Physician 103(7): 407-16 [PubMed]

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