Table 1.
Timing of Vaccination in People With HIV
| Vaccine | CD4+ count criteria | Source |
|---|---|---|
| Mpox | Give regardless of CD4+ count | ACIP guidelines3 |
| PCV20 | Give regardless of CD4+ count (OI guidelines) or when CD4+ count is ≥200 cells/µL | OI guidelines2 |
| PPSV23 | Preferably defer until CD4+ count is >200 cells/µL | OI guidelines2 |
| RSV | Presumably give regardless of CD4+ count as it is not a live vaccine and is given in the fall | — |
| Tdap | Give regardless of CD4+ count | Adult immunization schedule4 |
| Varicella | Give only when CD4+ count is ≥200 cells/µL | Adult immunization schedule4 |
| Yellow fever | Give only when CD4+ count ≥200 cells/µL | Adult immunization schedule4 |
| Herpes zoster | Give recombinant vaccine regardless of CD4+ count; discussion suggests lower humoral and cellular immune responses in persons with low CD4+ count | Berkowitz et al5 |
| COVID-19 | Give regardless of CD4+ count | CDC4 and NIH COVID-19 treatment guidelines6 |
| Hepatitis A | Give regardless of CD4+ count | OI guidelines2 and adult immunization schedule4 |
| Hepatitis B | Give regardless of CD4+ count; in nonresponders, can delay revaccination until CD4+ count is ≥200 cells/µL and sustained with antiretroviral therapy | OI guidelines2 |
| HPV | Immune responses appear stronger among those with higher CD4+ counts and suppressed HIV viral loads | OI guidelines2 |
| Influenza | Give regardless of CD4+ count | Adult immunization schedule4 |
| MMR | Give only when CD4+ count is ≥200 cells/µL | Adult immunization schedule4 |
| Meningococcal conjugate | Better immunogenicity if CD4+ count percentage is >15% but deferral is not specifically recommended | MacNeil et al7 |
Abbreviations: ACIP, Advisory Committee on Immunization Practices; CDC, Centers for Disease Control and Prevention; HPV, human papillomavirus; MMR, measles, mumps, and rubella; NIH, National Institutes of Health; OI, opportunistic infection; PCV20, pneumococcal conjugate vaccine (protects against 20 serotypes); PPSV23, pneumococcal polysaccharide vaccine (protects against 23 serotypes); RSV, respiratory syncytial virus; Tdap, tetanus, diphtheria, and pertussis.