Case 4: Immunizations for HIV-Infected Persons

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	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.

This answer is incorrect. Annual influenza vaccine is recommended for all persons infected with HIV. The killed influenza virus vaccine does not pose a risk of active influenza infection. The live attenuated intranasal influenza vaccine (Flumist) is not recommended for HIV-infected persons. Although early studies suggested influenza vaccine might adversely affect HIV RNA levels, prospective studies have not found influenza vaccination to result in significant adverse effects on HIV RNA levels, CD4 counts, and progression of HIV disease.

	Pneumococcal vaccine should be deferred until the patient’s CD4 count declines to less than 200 cells/mm³.
	The patient should receive the hepatitis A virus vaccine series.
	Varicella serology should be checked and, if negative, the zoster vaccine (Zostavax) should be given.

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