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Vaccinations in the Setting of HIV Infection


1. As a general rule, live vaccines should be avoided in persons infected with HIV and particularly in persons with symptomatic HIV or AIDS.

2. Revaccination should be considered in the setting of immune reconstitution (e.g. CD4-lymphocyte increases from less than 200 to over 200.)

3. Due to their transient effects on HIV viral load, delay vaccinations while evaluating new antiretroviral therapy or possible adverse trends in virologic suppression (i.e. rising HIV viral loads)


Vaccine Indication Dose & Frequency Comment
Pneumococcus HIV 1 cc IM every 5-6 years Revaccinate after immune reconstitution?
Influenza HIV 1 cc IM every year in Oct/Nov Hold vaccination for CD4 < 100
Adult diphtheria/tetanus (dT) General population 1 cc IM every 10 years or after high risk exposure and last vaccination > 5 years  
Measles, mumps, rubella (MMR) HIV Once Hold vaccination for AIDS
Inactivated polio vaccine (IPV) HIV-infected persons who are either
1. Travelers to endemic areas
2. Healthcare workers who might treat persons with polio
Doses at 0, months 1-2, and months 6-12 Oral polio vaccine contraindicated
Hepatitis B HIV 1 cc IM week 0, week 4, and at 6-12 months or after exposure Check hepatitis B surface antibody level after series to verify immunity
Hepatitis A


Men who have sex with men
Travel to endemic area inc Mexico
Substance users
Recipients of clotting factor concentrates
Chronic liver disease
1 cc IM at 0 and 6 months  
Smallpox Contraindicated in HIV Contraindicated in HIV Risk of disseminated vaccinia infection
Varicella-Zoster Age > 60 years 0.65 cc subcutaneously Contraindicated for immunocompromised (including AIDS, leukemia, lymphoma, immunosuppressive therapy) allergy to gelatin or neomycin, or pregnancy



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Updated 1/18/2013