Hi Dr. Would you recommend the shingles vaccine for an hiv+ male with a cd4 count around 750 and an undetectable VL (with meds)? I'm 55 and had a relatively mild bout with Shingles about 20 years ago. Thank you.

The approved zoster vaccine (Zostavax) is a a live, attenuated strain of VZV. In a large clinical trial, zoster vaccine was partially efficacious at preventing zoster. It also was partially efficacious at reducing the severity and duration of pain and at preventing PHN among those developing zoster.

Zoster vaccine is recommended for all persons aged >60 years who have no contraindications, including persons who report a previous episode of zoster or who have chronic medical conditions. It is administered as a single 0.65 mL dose subcutaneously in the deltoid region of the arm. Zoster vaccination is not indicated to treat acute zoster, to prevent persons with acute zoster from developing PHN, or to treat ongoing PHN. Recipients should not be on anti-herpes medications at the time of vaccination. There is a spcific contrindication for 'persons with AIDS or other clinical manifestations of HIV, including persons with CD4+ T-lymphocyte values <200 per mm3 or <15% of total lymphocytes'. So while you have a great CD4 count the vaccine is not indicated for you (based on being too young and being HIV+). The varicella zoster vax (a different live vaccine) has been shown to be safe, immunogenic, and effective in children with HIV infection whose CD4+ T-lymphocyte percentage is 25% or greater. This may be a discussion point with your provider. I could not find evidence of studies investigating this issue being on-going Hope this helps Dr Moyle