Question | Discussion | References | CME Credit

Updated January 17, 2013

Case 4: Immunizations for HIV-Infected Persons

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

Learning Objectives

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 recommended immunizations for this adult patient?

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