14
Patient Management
Table 4. Routine Immunizations for HIV-Infected Adults
(continued)
Vaccine Status Dose/Regimen Comments
Pneumococcal Recommended Should receive a
dose of PCV13
(Prevnar 13
®
),
followed by a
dose of PPV23
(Pneumovax
®
23) at least 8 wk
later.
If previously
vaccinated with
PPV23, give
PCV13 at least
1 y aer PPV23.
• Administer to patients
with CD4 cell count
≥200/µL
• A second PPV23 dose is
recommended 5 y after
first PPV23 dose
Polio OPV
contraindicated;
IPV should be
given if indicated
0.5 mL SC; 3
doses over 6–12
mo for primary
immunization
• For travelers to an area
endemic for polio
Tetanus toxoid Same as for patient
without HIV
infection
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 y
• Precautions with
pregnancy
• Td may be administered
after 20 wk gestation or
immediately postpartum
Varicella
(primary)
Consider in
selected settings
(see comments)
0.5 mL IM
as 2 doses
administered 3
mo apart
• Administer to HIV-
infected persons with
CD4 cell count ≥200/
µL who do not have
evidence of immunity to
varicella
Zoster See comments • Safety and efficacy in
HIV-infected persons
are unknown; consider
in patients >60 y of age
with CD4 cell count
≥200/µL
