What is the primary prophylaxis against varicella-zoster virus infection in patients with HIV infection?

Updated: Mar 09, 2021
  • Author: Justin R Hofmann, MD; Chief Editor: John Bartlett, MD  more...
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HIV-infected patients should generally avoid close contact with persons with zoster or chickenpox.

Live-virus vaccines should not be administered to persons with HIV and CD4 counts lower than 200 cells/µL (AIII recommendation). Guidelines continue to recommend varicella immune globulin (AIII recommendation) for postexposure prophylaxis, and to consider a 7- to 10-day course of acyclovir or valacyclovir in this situation (BIII recommendation). [1]

There are limited data for use of the recombinant zoster vaccine (RZV) in patients with HIV, although the CDC’s Advisory Committee on Immunization Practices has not recommended use in this manner. A phase 1/2 randomized placebo-controlled trial of 123 patients with HIV who were given RZV according to the FDA-approved schedule for persons without HIV showed increased humoral and cell-mediated immunity against VZV. [1, 40]  This included patients with CD4 counts of less than 200 cells/mm3. No vaccine-related severe adverse events occurred, though side effects (injection site pain, fatigue, myalgia, headache) were common. [40]

Given the lifetime risk for zoster and the safe profile of the vaccine, experts recommend administration of RZV to persons with HIV who are 50 years of age or older according to the FDA-approved schedule for persons without HIV (IM dose at 0 and 2 months) (AIII recommendation). [1]

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