Case 4: Appropriate Vaccinations

Question | Discussion | References | CME Credit

Authors: John V. L. Sheffield, MD
David H. Spach, MD

Case last updated: April 24, 2008

35-year-old HIV-infected woman presents to clinic with recently diagnosed HIV infection. Her risk factors for acquiring HIV disease consist of injection-drug use and heterosexual sex with a partner known to have HIV. Initial laboratory tests show a CD4 count of 426 cells/mm3, HIV RNA of 32,000 copies/mm3, negative total hepatitis A virus antibody, negative hepatitis B virus surface antigen, positive antibody to hepatitis B surface antigen (anti-HBsAg), positive antibody to hepatitis B core antigen (anti-HBc), and positive hepatitis C virus antibody. Subsequent laboratory testing showed a hepatitis C virus RNA level of 2,300,000 copies/ml. The patient reports that she received all required childhood vaccinations and received a tetanus booster 2 years ago, but she does not recall ever having chicken pox or shingles.

Which one of the following is TRUE regarding vaccinations for this patient?

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