Which vaccines are administered to prevent opportunistic infections in patients with HIV infection?

Updated: Mar 09, 2021
  • Author: Justin R Hofmann, MD; Chief Editor: John Bartlett, MD  more...
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Answer

All HIV-positive adolescents and adults who have never had a pneumococcal vaccine should receive a single dose of PCV13 at presentation (AI recommendation). If CD4 cell count is higher than 200 cells/µL, they should receive a 23 valent polysaccharide vaccine (PPV23) at least 8 weeks later (AII recommendation). Those with a CD4 cell count of less than 200 cells/µL should preferably wait until the CD4 count is higher than 200 cells/µL with antiretroviral therapy (ART) before receiving the PPV23 (BIII recommendation). PCV13 should be given to patients who have previously received PV23 (AII recommendation) more than a year prior (AII recommendation). [1]

Other recommended vaccinations are as follows:

Hepatitis B virus infection - All susceptible (anti-HBc-negative) patients should receive the 3-dose hepatitis B vaccine (AII recommendation)

Influenza virus infection - Annual seasonal influenza vaccination is recommended by ACIP for all patients with HIV over the age of 6 months. Live attenuated intranasal vaccine (LIAV) should not be used in patients with HIV. While there is no recommendation for high dose influenza vaccination, a randomized trial of high vs standard dose in HIV-infected adults showed increased seroprotection rates against H1N1 (96 vs 87%) and influenza B (91 vs 80%), but not H3N2 (96 vs 92%). [41]

Hepatitis A virus infection - All susceptible (anti-HAV-negative) patients should receive the 2-dose hepatitis A vaccine (AII recommendation)

The 9-valent recombinant human papillomavirus (HPV) vaccine (0.5 mL at 0, 1-2, and 6 months) is recommended in HIV-positive males and females aged 11-26 years (AIII recommendation), even if they have received previous bivalent or quadrivalent vaccines (CIII recommendation) plus ages 27-45 years based on shared decision making. [1]

Meningococcal ACWY - Two doses 2 months apart and every 5 years

Tetanus, diphtheria, and pertussis - Tdap if not previously vaccinated, followed by Td booster every 10 years

Measles, mumps, rubella - Two-dose series at least 1 month apart in adults and adolescents without historical or serological evidence of immunity and a CD4 count >200 cells/µL

Varicella - Two-dose series at least 3 months apart in adults and adolescents without historical or serological evidence of immunity and a CD4 count >200 cells/µL


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