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Which immunizations are routinely recommended for HIV-infected patients


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Which immunizations are routinely recommended for HIV-infected patients?

Live virus or live bacteria vaccines, with the exception of the measles-mumps-rubella vaccine (MMR), should not be given to HIV-infected individuals. Although it is a live virus vaccine, the MMR vaccine is considered safe for HIV-infected patients, and the indications for administration are the same as in immunocompetent adults. All other live vaccines are contraindicated, including BCG, oral polio vaccine, oral typhoid vaccine (Ty21a), varicella-zoster vaccine, and yellow fever vaccine. If polio vaccination is indicated for HIV-infected individuals or their household contacts, the enhanced-potency inactivated polio vaccine (eIPV) should be used.
The pneumococcal polysaccharide vaccine is considered the standard of care because of the high incidence of pneumococcal pneumonia and bacteremia associated with HIV disease. The influenza vaccine should be considered to prevent influenza and its potential complications (primarily bacterial pneumonia) and to prevent clinical syndromes that may mimic more serious opportunistic infections. Although the data are conflicting, there is some evidence that influenza vaccination leads to a transient rise in viral load.
Following screening for past exposure, hepatitis B vaccine should be offered to HIV-infected injection drug users; sexually active gay men; prostitutes; sexually active heterosexual men and women with STDs or more than one partner in the past 6 months; and household or sexual contacts of HBsAg carriers. Hepatitis A vaccine can be given safely to HIV-infected patients at risk -- primarily those with negative anti-HAV IgG who are traveling to an endemic area, sexually active gay men, injection drug users, or those exposed to a community outbreak.
Authorities differ on whether Haemophilus influenza type-B vaccine should be offered. Recommendations for the tetanus-diphtheria (dT) vaccine do not differ from those for immunocompetent adults.

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