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Case 4: Immunizations for HIV-Infected Persons

You answered:

A Pneumococcal vaccine should be deferred until the patient’s CD4 count declines to less than 200 cells/mm3.

This answer is incorrect. Pneumococcal vaccine is recommended for all HIV-infected persons. Because of diminished vaccine immune responses in patients with severe immune deficiency, it is preferable to administer pneumococcal vaccine before the CD4 count decreases to less than 200 cells/mm3. For patients with a CD4 count less than 200 cells/mm3, it is preferable to delay giving pneumococcal vaccine until sustained immune reconstitution occurs as a result of antiretroviral therapy. In 2012, the Advisory Committee on Immunization Practices recommended that HIV-infected patients receive both the conjugate pneumococcal vaccine (PCV13; Prevnar 13) and the polysaccharide pneumococcal vaccine (PPSV23; Pneumovax 23).

Choose another answer:

B The patient should receive the hepatitis A virus vaccine series.
C Influenza vaccine should not be given to this patient because influenza vaccine is likely to cause a marked increase in HIV RNA levels, a significant decline in CD4 cell count, and an acceleration of HIV disease.
D Varicella serology should be checked and, if negative, the zoster vaccine (Zostavax) should be given.

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