From the Guidelines
The recommended varicella vaccine for an HIV positive renal transplant recipient is the live-attenuated varicella vaccine, administered in a 2-dose schedule separated by a 3-month interval 1.
Key Considerations
- The vaccine should be given to patients without evidence of varicella immunity, and it is essential to administer it ≥4 weeks before initiating immunosuppressive therapy if possible 1.
- For renal transplant recipients, varicella vaccination has been shown to be well tolerated and effective in inducing VZV antibody in 75%–85% of patients 1.
- A systematic review and meta-analysis found that varicella vaccination in transplant recipients, including those with solid organ transplants, was overall safe and immunogenic, although the proportion of recipients who seroconverted was lower than that seen in the general population 1.
Important Details
- The live-attenuated varicella vaccine is recommended for patients with HIV infection without severe immunosuppression, and it is crucial to adhere to the recommended 2-dose schedule separated by a 3-month interval 1.
- The vaccine's safety and efficacy in renal transplant recipients have been demonstrated, but it is essential to carefully control maintenance immunosuppression and immunologic specifications 1.
From the Research
Varicella Vaccine Recommendations for HIV Positive Renal Transplant Recipients
- The live attenuated varicella vaccine is not recommended for solid-organ transplant recipients, including kidney transplant recipients, due to the risk of vaccine-derived varicella zoster infection 2, 3.
- Recombinant subunit varicella-zoster vaccine may be considered as an alternative for varicella prevention in immunocompromised adults, including HIV positive renal transplant recipients 2, 3.
- Vaccination against varicella zoster virus prior to kidney transplantation is recommended, especially for VZV-seronegative patients, to prevent severe disease 4, 5.
- The safety and efficacy of recombinant varicella-zoster vaccine for primary varicella prevention in VZV-seronegative immunocompromised adults, including HIV positive renal transplant recipients, require further study 3.
- Live attenuated varicella vaccine can induce a positive serologic response in VZV-seronegative kidney transplant candidates, but its use is contraindicated in solid-organ transplant recipients 4, 6, 5.