Case 4: Immunizations for HIV-Infected Persons

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	Varicella serology should be checked and, if negative, the zoster vaccine (Zostavax) should be given.

This answer is incorrect. The zoster vaccine contains high-titer, live, attenuated varicella-zoster virus and is not appropriate for use in patients such as this who do not have immunity to varicella-zoster virus. The Advisory Committee on Immunization Practices (ACIP) recommends that varicella vaccine (Varivax) may be considered for HIV-infected persons who are not immune to varicella-zoster virus and who have a CD4 count of at least 200 cells/mm³. The titer of varicella-zoster virus in the varicella vaccine is much lower than in the zoster vaccine.

	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.
	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.

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