Table 3.
Recommended Immunizations for People With HIV, by Agea
| Disease(s) | Vaccination recommendation by age | |||
|---|---|---|---|---|
| 19-26 y | 27-59 y | 60-64 y | ≥65 y | |
| Influenza | 1 dose of influenza vaccine annually | 1 dose (high dose) annually | ||
| Tdap | 1 dose of Tdap, then Td or Tdap booster every 10 y | |||
| Varicella infection | 2 doses, 3 mo apart (if CD4+ count is ≥200 cells/µL and no immunity to varicella virus) | |||
| HPV | 3 doses (0, 2, and 6 mo) | 27-45 yb | — | — |
| Herpes zoster infection | Recombinant vaccine: 2 doses at 0 and 2-6 mo | |||
| MMR | 1 or 2 doses (if CD4+ count is ≥200 cells/µL and no immunity to MMR viruses) | — | ||
| Pneumococcal disease | See Table 2 | |||
| Hepatitis A | 2 or 3 doses depending on the vaccine, at 0 and 6-18 mo. Check HAVAb 1-2 mo after. | |||
| Hepatitis B | 2 or 3 doses depending on the vaccine. Check HBsAb 1-2 mo after. | |||
| Meningococcal disease | If no prior vaccine, 2 doses of MenACWY 8-12 wk apart. Boost every 5 y. Group B vaccine given in special circumstances (see ACIP guidelines3). | |||
| Mpox | 2 doses separated by 28 days for those at riskc | |||
| RSV | — | — | 1 dosed | |
| COVID-19 | The 2023-2024 formulations of the COVID-19 vaccine are available from several manufacturers. See CDC guidance.8 | |||
Immunizations should be given after assessment of age, presence of immunity to the pathogen (for hepatitis A and B), and CD4+ counts. Live replicating vaccines, including MMR, varicella, and yellow fever, should not be given if CD4+ count is less than 200 cells/µL. The oral live influenza vaccines are contraindicated in all people with HIV. Recommendations current as of October 2023.
HPV vaccination for individuals aged 27 to 45 years should be approached with shared decision-making between the clinician and patient to assess for ongoing risk of exposure to HPV.
Individuals at risk for mpox include those who may have contact with mpox through workplace or sexual exposure.
RSV vaccination is recommended for those with cardiopulmonary disease, kidney disorders, liver disorders, neurologic or neuromuscular conditions, hematologic disorders, diabetes mellitus, or moderate or severe immune compromise (attributable to either a medical condition or receipt of immunosuppressive medications or treatment); persons who are frail; persons of advanced age; persons who reside in nursing homes or other long-term care facilities; and persons with other underlying conditions or factors that the practitioner determines might increase the risk for severe respiratory disease.
Abbreviations: ACIP, Advisory Committee on Immunization Practices; CDC, Centers for Disease Control and Prevention; HAVAb, hepatitis A virus antibody; HBsAb, hepatitis B surface antibody; HPV, human papillomavirus; MenACWY, meningococcal disease caused by serogroups A, C, W, and Y; MMR, measles, mumps, and rubella; RSV, respiratory syncytial virus; Td, tetanus and diptheria; Tdap, tetanus, diptheria, and pertussis.