context: If you have HIV (human immunodeficiency virus) or AIDS (acquired immunodeficiency syndrome), you should take special precautions against other infections, such as the flu. That's because you have a disease that makes it difficult for your immune system to fight them. Vaccines (i mmunizations) can help your body defend itself against some of these infections. Not all vaccines are safe for people with HIV/ AIDS. Vaccines made from live viruses should not be given to persons with CD4 counts less than 200 because they contain a weak form of the germ and may cause a mild case of the disease. Fortunately, most of the vaccines for people with HIV/ AIDS are âinactivatedâ vaccines, which don't contain a living germ. Anyone, regardless of their HIV status, is at risk of side effects associated with vaccines, including: Pain, redness, or swelling at the place where you receive the shot Fatigue If you have HIV/ AIDS, additional considerations about vaccines include: Vaccines may increase your viral load Vaccines may not work as well if your CD4 count is very low. If your CD4 count is low, it may help to take strong antiretroviral medications before receiving some of the vaccines. Vaccines made from a live virus may cause you to get the disease the vaccine is supposed to prevent. If your CD4 count is low, you should avoid live vaccines, such as chickenpox, measles/mumps/rubella ( MMR), and the flu vaccine in the form of a nose spray. Also, avoid close contact with anyone who has had a live vaccine in the past two or three weeks. Vaccines may increase your viral load, although this is of little consequence in persons receiving antiretroviral therapy. Here are general guidelines about vaccines for people with HIV. These will help you know which to take and how often. Recommended for All Adults Who Are HIV- Positive Vaccine/disease Dosage Recommendations Hepatitis B virus ( HBV) three shots over six months Receive unless you are a hepatitis B carrier or immunity is present. After the series is completed, get a blood test to check for immunity. If it's too low, you may need extra shots. Influenza [flu] one shot Receive injectable flu vaccine only. Repeat every year by mid- November for best protection. Measles, mumps, and rubella ( MMR) (live virus vaccine) two shots over one month Not needed, if you were born before 1957 Receive only if your CD4 cell count is above 200. You can receive individual components separately. Polysaccharide pneumococcal (pneumonia) one or two shots Receive soon after HIV diagnosis, unless you've been vaccinated within the last five years. Effective within two to three weeks. If given when CD4 count is less than 200, repeat once CD4 count reaches 200. Repeat every five years. Pneumococcal (pneumonia) conjugate vaccine ( PCV13) one shot Receive soon after HIV diagnosis Pneumococcal (pneumonia) polysaccharide vaccine( PPSV23) one shot Receive soon after HIV diagnosis, but wait 2 months after receiving PCV13 If your CD4 count is less than 200, consider waiting to receive this vaccine until your CD4 count is above 200 on antiretroviral therapy. Repeat after five years and one more time (if 5 years have elapsed since the last dose) at age 65 Tetanus and diphtheria toxoid ( Td) or Tdap ( Tetanus, diphtheria and pertussus) one shot Repeat every 10 years. Get it earlier if you have an injury such as a cut that requires stitches. Recommended for Some Adults Who Are HIV- Positive Hepatitis A virus ( HAV) two shots over 6 months Receive only if you are susceptible (don't have antibodies) to Hepatitis A Recommended for health care workers, men who have sex with men, injection drug users, people with chronic liver disease, hemophiliacs, and people traveling to certain parts of the world. If your CD4 count is less than 200, consider waiting to receive this vaccine until your CD4 count is above 200 on antiretroviral therapy. Hepatitis A/ Hepatitis B combined virus ( Twinrix) three shots over 6 months This is available for people who require both HAV and HBV vaccinations. Human papillomavirus ( HPV) 3 shots over 6 months Up to age 26 only. Do not receive if you are pregnant. Meningococcal (bacterial meningitis) two shots over 2 months If you have HIV, be sure to get vaccinated against hepatitis A and B if you are not already immune. Make sure your routine vaccines are up to date and that you have the ones that are required by the country you're traveling to. However, make sure these are the inactivated, not the live, vaccines. If an inactivated version is not available, do not get the live vaccine. Examples of live vaccines include some forms of typhoid fever vaccine and yellow fever vaccine. Instead, have your doctor provide a letter explaining that you are medically unable to be vaccinated.