Patients with preserved or restored immune function are more likely to have a favorable immunologic response to vaccines than those who are significantly immunocompromised. However, killed or inactivated vaccines are considered safe. Influenza and other vaccine preparations have been shown to transiently stimulate HIV replication and increase viral load. 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 initial immunization.
Hepatitis B immunization series should be given to patients who have a negative screening serologic test. Hepatitis A vaccine should be administered to homosexual and bisexual men and to patients with chronic hepatitis C infection. Whether to give 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 it should be administered in asplenic patients and in those with history of recurrent hemophilus infection.