Vaccination Schedule: HIV-Infected Adults

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This schedule summarizes recommendations for routine administration of vaccines for HIV-infected adults based on CD4 count. For more information on the following immunizations, refer to the vaccination schedule of the Advisory Committee on Immunization Practices (ACIP) and the Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents.
Recommended for all persons who meet the age requirement, lack documentation of vaccination, or lack evidence of past infection Recommended for persons with a risk factor (medical, occupational, lifestyle, or other indication)
    CD4 T-lymphocyte count  
Vaccine   <200 cells/µL ≥200 cells/µL  
Influenza1   1 dose annually  
Tetanus, diphtheria, pertussis (Td/Tdap)   Substitute Tdap for Td once, then Td booster every 10yrs  
Measles, mumps, rubella (MMR)2 Contraindicated 2 doses  
Varicella (VAR)3 Contraindicated 2 doses  
Herpes Zoster (HZV) Contraindicated    
Human papillomavirus (HPV) Female4   3 doses through age 26yrs  
Human papillomavirus (HPV) Male4   3 doses through age 26yrs  
Pneumococcal 13-valent conjugate (PCV13)5   1 dose  
Pneumococcal polysaccharide (PPSV23)5   2 or 3 doses  
Hepatitis A6   2 or 3 doses  
Hepatitis B7   3 doses  
Meningococcal 4-valent conjugate (MenACWY) or polysaccharide (MPSV4)8   2 doses, then every 5yrs  
Meningococcal B (MenB)9      
Haemophilus influenzae type b (Hib)10      

  1 Inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV). Live attenuated influenza vaccine (LAIV) is not recommended for HIV-infected persons.

  2 Two doses should be at least 28 days apart.

  3 Two doses should be given 3 months apart.

  4 Give 3-dose series at 0, 1–2, and 6mos.

  5 Give 1 dose of PCV13, followed by 1 dose of PPSV23 at least 8wks later. The second dose of PPSV23 should be given at least 5yrs after the first PPSV23 dose. If the last PPSV23 was given at <65yrs, at age 65, give another PPSV23 dose at least 8wks after PCV13 and at least 5yrs after the last PPSV23 dose. Pneumococcal vaccines should be given as soon as possible after HIV diagnosis.

  6 2-dose series (single-antigen HepB vaccine): Havrix at 0 and 6–12mos or Vaqta at 0 and 6–18mos. 3-dose series (combined HepA-HepB vaccine): Twinrix at 0, 1, and 6mos.

  7 3-dose series of single-antigen HepB vaccine (Engerix-B, Recombivax HB) or combined HepA-HepB vaccine (Twinrix) at 0, 1, and 6 mos.

  8 Previously unvaccinated persons should receive a 2-dose series at least 2mos apart. If previously vaccinated, give second dose at least 2mos after the first dose. Revaccinate every 5yrs.

  9 Not routinely recommended. Meningococcal disease in HIV is caused primarily by serogroups C, W, and Y.

10 Not routinely recommended. Risk for Hib infection in HIV is low.


For information on individual vaccines, please see product monographs at, contact company for full labeling, or call the National Immunization Hotline at (800) 232-4636.

Source: Advisory Committee on Immunization Practices (ACIP). Recommended Immunization Schedule for Adults Aged 19 Years or Older by Medical Conditions and Other Indications—United States, 2017.

Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents. 2013 May.

(Rev. 8/2017)

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