Initiation of combination antiretroviral therapy in patients with advanced HIV disease may improve the immunologic response to vaccine preparations. However, killed or inactivated vaccines are considered safe in this population. Influenza and other vaccine preparations have been shown to transiently stimulate HIV replication and increase viral load titer. This phenomenon does not appear to have an impact on overall disease progression. Pneumococcal vaccine should be administered to all HIV-infected patients.
Some experts recommend a booster dose five years after immunization.
Hepatitis B immunization series should be administered to patients who have a negative screening serologic test for this infection. Consideration of administering influenza vaccine should be individualized based upon historical risk factors for exposure to the virus and the presence of conditions associated with increased morbidity from influenza infection. Routine use of hemophilus B vaccine is not recommended but should be administered in asplenic patients and in those with history of recurrent hemophilus infection.