Vaccination Schedule: HIV-Infected Adults

VACCINATION SCHEDULE: HIV-INFECTED ADULTS
This schedule summarizes recommendations for routine administration of vaccines for HIV-infected adults based on CD4 count. For more information on the following immunizations, refer to the vaccination schedule of the Advisory Committee on Immunization Practices (ACIP) and the Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents.

Recommended for persons with HIV infection	Recommended for persons with a risk factor (medical, occupational, lifestyle, or other indication)		No recommendation

		CD4 T-lymphocyte count
Vaccine		<200 cells/µL		≥200 cells/µL
Influenza¹		1 dose annually
Tetanus, diphtheria, pertussis (Td/Tdap)		1 dose Tdap, then Td booster every 10yrs
Measles, mumps, rubella (MMR)²		Contraindicated		2 doses
Varicella (VAR)³		Contraindicated		2 doses
Zoster vaccine live (ZVL)		Contraindicated
Recombinant zoster vaccine (RZV)
Human papillomavirus (HPV) Female⁴		3 doses through age 26yrs
Human papillomavirus (HPV) Male⁴		3 doses through age 26yrs
Pneumococcal 13-valent conjugate (PCV13)⁵		1 dose
Pneumococcal polysaccharide (PPSV23)⁵		2 or 3 doses
Hepatitis A⁶		2 or 3 doses
Hepatitis B⁷		3 doses
Meningococcal 4-valent conjugate (MenACWY)⁸		2 doses, then every 5yrs
Meningococcal B (MenB)⁹		2 or 3 doses
Haemophilus influenzae type b (Hib)¹⁰		1 or 3 doses
NOTES
¹ Inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV). Live attenuated influenza vaccine (LAIV) is not recommended for HIV-infected persons. ² Give 2 doses at least 28 days apart to patients with CD4 count ≥200 cells/µL for ≥6mos with no evidence of immunity to MMR. ³ Two doses should be given 3 months apart. ⁴ Give 3-dose series at 0, 1–2, and 6mos. ⁵ Give 1 dose of PCV13, followed by 1 dose of PPSV23 at least 8wks later. The second dose of PPSV23 should be given at least 5yrs after the first PPSV23 dose. If the most recent PPSV23 was given before 65yrs, at age 65yrs or older, give another PPSV23 dose at least 5yrs after the last PPSV23 dose. Pneumococcal vaccines should be given as soon as possible after HIV diagnosis. ⁶ Give to adults with a specific risk factor, or lack a risk factor but want protection. 2-dose series (single-antigen HepA vaccine): Havrix at 0 and 6–12mos or Vaqta at 0 and 6–18mos. 3-dose series (combined HepA-HepB vaccine): Twinrix at 0, 1, and 6mos. ⁷ 3-dose series of single-antigen HepB vaccine (Engerix-B, Recombivax HB) or combined HepA-HepB vaccine (Twinrix) at 0, 1, and 6 mos. ⁸ Give 2 doses at least 8wks apart. Revaccinate with 1 dose every 5yrs, if risk remains. ⁹ Not routinely recommended. May give 2-dose series (Bexsero) at least 1 month apart or a 3-dose series (Trumenba) at 0, 1–2, and 6mos for patients with asplenia, persistent complement component deficiency, on eculizumab therapy, at risk from MenB outbreak, or microbiologists. ¹⁰ Not routinely recommended. Give 1 dose to patients with asplenia or 3 doses to patients with HSCT.
REFERENCES
For information on individual vaccines, please see product monographs at www.eMPR.com, contact company for full labeling, or call the National Immunization Hotline at (800) 232-4636. Source: Advisory Committee on Immunization Practices (ACIP). Recommended Immunization Schedule for Adults Aged 19 Years or Older by Medical Conditions and Other Indications—United States, 2018. https://www.cdc.gov/vaccines/schedules/hcp/imz/adult-conditions.html Panel on Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf. Accessed July 18, 2019 [Figure 1]. (Rev. 8/2019)

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