Primary Care Management of HIV-Infected Patients

Primary Care Management of HIV-Infected Patients

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Dose/Regimen Comments 0.5 mL IM Administer to asplenic patients and those with history of recurrent Haemophilus infection. 1 mL IM with revaccination in 6-12 months for Havrix® or 6-18 months for Vaqta®; also available in combination with hepatitis B vaccine as Twinrix® administered as 3 or 4 dose Hepatitis A vaccination is recommended for all susceptible men who have sex with men, as well as others with indications for hepatitis A virus vaccine (eg, injection drug users, persons with chronic liver disease or who are infected with hepatitis B and/or C). Engerix B® 20 μg or Recombivax HB® 10 μg IM given at 0, 1, and 6 months; also available in combination with hepatitis A vaccine as Twinrix® administered as 3 or 4 dose Administer to patients without evidence of past or present hepatitis B infection. Vaccinated patients should be tested for HBsAb response after the third dose; higher dose (40 μg) booster or series may be considered for nonresponders. Gardasil® 0.5mL IM for 3 dose series given at 0, 2, and 6 months Safety and immunogenicity studies in those with HIV infection are on-going. 0.5 mL IM annually ALL patients, especially important in patients at high risk for exposure to or morbidity from influenza. 0.5 mL IM of the 23 polyvalent polysaccharide vaccine Administer to patients with CD4 cell count ≥ 200/mm3. Consider booster dose 5 years after initial immunization. 0.5 mL SC; three doses over 6-12 months for primary immunization Td 0.5 mL IM Tdap 0.5-0.75 mL IM as per package insert Substitute 1 time dose of Tdap vaccine at time of next booster, then Td every 10 years. Precautions with pregnancy. Td may be administered during 2nd or 3rd trimester or defer Td during pregnancy and administer Tdap postpartum 0.5 mL IM as 2 doses administered 3 months apart Administer to HIV-infected persons with a CD4 count ≥ 200 cells/mm3 who do not have evidence of immunity to varicella 9

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