12 Recommended Vaccinations for Adults with HIV

Efficacy and Safety of Protective Vaccines on HIV-Infected Adults

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There are a number of key vaccinations recommended for adults living with HIV. While the recommendations are similar to those for non-infected individuals, HIV can sometimes lower the efficacy of certain vaccines, particularly in those with compromised immune systems, and, as such, may require dose adjustments or other considerations.

As a rule of thumb, people with HIV should not be immunized with live attenuated vaccines.

These are vaccines that use a weakened form of a live, disease-causing virus to effect an immunologic response. The concern is that even a weakened virus can potentially cause disease in those with severely depleted immune defenses.

By contrast, vaccines that employ a inactivated (or "killed") virus do not represent danger to immune compromised individuals. There are exceptions, of course, but even in persons with a robust immune response, it is typically suggested that killed virus vaccines be chosen over live attenuated options.

[For example, flu shots are acceptable for people with HIV (since a killed form of virus is used), nasal sprays like FluMist are not (as they deliver live attenuated virus).]

It is important to note that while some immunizations are recommended for all adults living with HIV, others are recommended only for those considered to be at high risk for certain diseases—either because of travel, age or increased rates of infection within vulnerable populations.

And finally, as with lab tests and all other forms of medical information, it is recommended that you keep a copy of your vaccination records in a secure place.

Recommended Vaccines for Adults with HIV, 18 Years of Age or Older

Vaccine TypeDosageRecommendation

Hepatitis A (HAV)

Two-dose series given over a one or 1.5 year period

Recommended for healthcare workers, men who have sex with men (MSM), injection drug users (IDUs), people with chronic liver disease hemophiliacs, and individuals traveling to parts of the world with higher rates of HAV (at least 2-4 weeks before departure).

Hepatitis B (HBV)

Two-, three-, or four-dose series over a 4-6 month period

Recommended for all adults with HIV unless there is evidence of immunity (past infection) or an active infection. Blood tests should be performed after immunization to check that HBV antibody response is adequate. If not, additional shots may be required.

Hepatitis A/B Combined Vaccine (Twinrix)

Three-dose series over a six month period, or four doses over one year

Can be used in those requiring both HAV and HBV immunization.

Haemophilus Influenzae Type B (HiB)

One shot

May be considered for immune-compromised individuals at higher risk for this bacterial influenza infection (including bacterial meningitis). Discuss with your doctor or healthcare provider.

Human papillomavirus (HPV)

Three-dose series over a six month period

Recommended for young men through the age of 21, young women through the age of 26, men who have sex with men (MSM), individuals with compromised immune systems through the age of 26 if they had not fully vaccinated when they were younger. Not recommended during pregnancy.

Influenza

One dose annually

Recommended for all adults with HIV, although only injectable flu vaccines should be administered. Avoid nasal spray flu vaccines.

Measles, Mumps and Rubella (MMR)

One or two shots

Recommended for adults with CD4 counts over 200 cells/mL. Not needed for individuals born before 1957.

Meningococcal

One or two shots

Recommended for college students or people traveling parts of the world that have increased rates of this bacterial borne disease (including meningococcal meningitis). May need to repeated in five years if still at risk of infection.

Pneumococcal (bacterial pneumonia)

One or two shots

Recommended for all adults with HIV soon after HIV is diagnosed unless vaccination has occurred within five years. If vaccination is given when the person's CD4 count is under 200 cells/mL, re-vaccinate once the CD4 count is over 200 cells/mL. Repeat one time after five years.

Tetanus and Diphtheria Toxoid (Td)

One shot

Repeat every ten years.

Tetanus, Diphtheria and Pertussis (Tdap)

One shot

Recommended for all adults 64 years of age or younger and should be given in place of the next Td booster. Can be given as soon as two years after the last Td booster for healthcare workers and people in close contact with babies under the age of 12 months.

Varicella (chickenpox)

Two-doses series over 4-8 weeks

Recommended for adults with CD4 counts over 200 cells/mL. Not needed for individual born before 1980. Not recommended during pregnancy. As a live attenuated vaccine, should not be use in persons with CD4 counts under 200 cells//mL.

Sources:

U.S. Department of Health and Human Services (DHHS). "Recommended Immunizations for HIV Positive Adults." Washington, D.C.; issued June 9, 2009; accessed July 1, 2014.

U.S. Centers for Disease Control and Prevention (CDC). "Hepatitis A FAQs for Healthcare Professionals." Atlanta, Georgia; access July 8, 2014.

U.S. Centers for Disease Control and Prevention (CDC). "Prevention and Control of Haemophilus influenzae Type b Disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP)." Mortality and Morbidity Weekly Report (MMWR).  February 28, 2014; 63(RR01):1-14.

U.S. Centers for Disease Control and Prevention (CDC). "HPV Vaccines." Atlanta, Georgia; access July 8, 2014.

U.S. Centers for Disease Control and Prevention (CDC). "Updated Recommendations for Use of Meningococcal Conjugate Vaccines --- Advisory Committee on Immunization Practices (ACIP), 2010." Mortality and Morbidity Weekly Report (MMWR). January 28, 2011; 60(03):72-76.

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