10
Diagnosis
Hepatitis A and B (HAV, HBV)
57. Those who are susceptible to infection should be vaccinated against
HBV. For those whose HBsAb levels are negative or <10 IU/mL after
a primary vaccine series, a second series is recommended using
higher doses or an additional dose. Ideally, revaccination should be
attempted after suppression of HIV viral load and improvement in
CD4 count.
58. Vaccination should be recommended for nonimmune sexual partners
of patients who are positive for HBsAg.
59. Patients who are negative for HBsAg and HBsAb but positive for
HBcAb should receive vaccination.
60. Vaccination for HAV is recommended for all nonimmune individuals,
especially those with indications for hepatitis A vaccine (e.g., persons
who inject drugs, those unstably housed, those with current or prior
incarceration, gay and bisexual men or transgender persons with
chronic liver disease, travelers to countries with high endemicity,
or persons who are infected with hepatitis B and/or C). HAV IgG
antibody should be repeated 1–2 months or at the next scheduled
visit after the second vaccine to assess for immunogenicity. A repeat
vaccine series is recommended for those who remain seronegative.
Human papillomavirus
61. Persons between 9–26 years of age should be vaccinated against
HPV, and persons with HIV 27–45 years who were not vaccinated or
inadequately vaccinated should be offered the vaccination series if
appropriate.
Varicella Zoster Virus
62. Patients who are susceptible to VZV (those who have not been
vaccinated, have no history of varicella or herpes zoster, or are
seronegative for VZV) should receive postexposure prophylaxis with
varicella zoster immune globulin (VariZIG) as soon as possible (but
within 10 days) after exposure to a person with varicella or shingles.
63. Varicella primary vaccination may be considered in VZV-
seronegative persons aged >8 years with CD4 cell counts >200
cells/µL and in children with HIV aged 1–8 years with CD4 cell
percentages >15%.
64. Recombinant zoster vaccine, two dose series, should be given to
those >50 years on ART with CD4 >200 cells/µL to prevent herpes
zoster.
