What vaccinations are recommended for a 25-year-old with Human Immunodeficiency Virus (HIV)?

Recommended Vaccinations for a 25-Year-Old with HIV

A 25-year-old with HIV should receive all age-appropriate inactivated vaccines plus specific additional vaccines including pneumococcal (PCV13 followed by PPSV23), hepatitis B (consider high-dose), meningococcal (2-dose series), annual influenza, HPV if not previously vaccinated, and hepatitis A, while avoiding live vaccines if severely immunocompromised. 1

Core Vaccination Recommendations

Pneumococcal Vaccines

• PCV13 (13-valent pneumococcal conjugate vaccine) should be administered first 1, 2
• PPSV23 (23-valent pneumococcal polysaccharide vaccine) should be given ≥8 weeks after PCV13 1, 2
• A second dose of PPSV23 should be administered 5 years after the first PPSV23 dose 1, 2
• Newer options like PCV20 or PCV21 may be considered as a single dose without need for PPSV23 2

Hepatitis B Vaccine

• Complete 3-dose series if not previously vaccinated 1
• Consider high-dose HepB vaccine (40 μg/dose) for better immune response 1
• Check anti-HBs 1-2 months after completion; if <10 mIU/mL, administer a second series 1

Meningococcal Vaccine

• Administer a 2-dose primary series of MCV4 (meningococcal conjugate vaccine) with doses 2 months apart 1
• Revaccination with MCV4 every 5 years is recommended for those who remain at increased risk 1

Influenza Vaccine

• Annual inactivated influenza vaccine (IIV) is strongly recommended 1
• Do NOT use live attenuated influenza vaccine (intranasal) 1

Human Papillomavirus Vaccine (HPV)

• Recommended for those aged 11-26 years who haven't completed the series 1
• Quadrivalent HPV vaccine (HPV4) is preferred over HPV2 due to additional protection against genital warts 1
• Administer as a 3-dose series at 0,2, and 6 months 1

Hepatitis A Vaccine

• Recommended as a 2-dose series at least 6 months apart 1
• Particularly important for men who have sex with men and persons who use injection drugs 1

Tetanus, Diphtheria, Pertussis Vaccines

• Tdap (tetanus, diphtheria, acellular pertussis) should be given if not previously received 1
• Td (tetanus, diphtheria) booster every 10 years thereafter 1

Considerations Based on CD4 Count

For CD4 Count ≥200 cells/mm³

• All inactivated vaccines recommended above
• Varicella vaccine may be considered if no evidence of immunity to varicella 1

For CD4 Count <200 cells/mm³

• All inactivated vaccines still recommended
• Avoid live vaccines (including varicella, zoster, and live attenuated influenza) 1
• PPSV23 still recommended but with weaker evidence for efficacy 1

Additional Vaccines for Special Circumstances

For Travel

• Inactivated polio vaccine (IPV) for travel to polio-endemic areas 1
• Additional travel vaccines based on destination

Vaccine Response and Monitoring

• Antibody response may be suboptimal compared to HIV-negative individuals 3, 4
• Factors associated with better vaccine response include:
  • CD4/CD8 ratio >0.8 4
  • CD4 nadir ≥200 cells/mm³ 4
  • Undetectable viral load (<40 copies/ml) 4
  • Age under 50 years 4

Common Pitfalls to Avoid

• Delaying vaccination in eligible patients increases risk of preventable diseases 2
• Incorrect sequencing of pneumococcal vaccines (administering PPSV23 before PCV13) can result in suboptimal immune response 2
• Administering live vaccines to severely immunocompromised patients (CD4 <200 cells/mm³) 1
• Failing to revaccinate with a second PPSV23 dose 5 years after the first 2
• Not checking antibody response after hepatitis B vaccination series 1

Multiple studies confirm that HIV-infected individuals have significantly higher risk of pneumococcal and other vaccine-preventable diseases compared to the general population, with risk persisting despite antiretroviral therapy 2, 5. Timely and appropriate vaccination is essential to reduce morbidity and mortality in this population.