|
Note:This is a live virus vaccine and should be given only to patients with CD4 counts >200 cells/mm3. If the vaccine causes infection, the patient should receive acyclovir.
POST-EXPOSURE PROPHYLAXIS:
- Risk:Close contact with person with varicella or zoster plus susceptibility as defined above.
- Prophylaxis: Varicella-zoster immune globulin (VariZIG) 125 IU/10 kg (to 625 IU) IM given within 96 hours of exposure. Alternatives are varicella vaccine if the CD4 count is >200/mm3 or a course of acyclovir.
Note:VariZIG available at 800-843-7477.
HERPES ZOSTER VACCINE:
This vaccine is a live attenuated high dose VZV vaccine intended to prevent shingles. This vaccine is recommended by the CDC for persons >60 years of age, but it is contraindicated in patients with HIV infection since safety and efficacy in this population has not been studied.
S. pneumoniae vaccine
INDICATION FOR PNEUMOVAX:
- CD4 count >200 cells/mm3 unless vaccinated in the past 5 years.
- Consider revaccination if > 5 years from the time of initial vaccination or if vaccine was given when the CD4 count was <200 cells/mm3 and has subseqently increased above that level (optional)
RISK: All patients with HIV infection. Risk for invasive pneumococcal infection was 50- to 100-fold greater than in patients without HIV infection in the pre-HAART era (Ann Intern Med 2000;132:182; JID 1996;173: 857; JAIDS 2001;27:35; Am J Respir Crit Care Med 2000; 162:2063).
VACCINE :Pneumovax 0.5 mL IM x 1
EFFICACY: Studies of pneumococcal vaccine efficacy in HIV-infected persons have shown variable results. A CDC report indicated 49% efficacy (Arch Intern Med 2000;160:2633), but others found poor efficacy in immunosuppressed hosts (NEJM 1986;315:1318; JAMA 1993;270: 1826). A controlled study in Uganda found increased rates of pneumonia in vaccine recipients (Lancet 2000;355:2106), but a subsequent report indicated that vaccine recipients had a reduction in all-cause mortality (AIDS 2004;18:1210). Patients with low CD4 counts show a poor antigenic response (J Infect Dis 2004;190:707) but those who respond to HAART have a good serologic response (Vaccine 2006;24:2563).The best evidence for benefit of
|
