Dear Dr Feinberg

I am tempted to seek out the chicken pox vaccine despite it being contraindicated in HIV-positive individuals. My understanding is that a live vaccine may result in a brief elevation of viral load sufficient to produce resistant mutations. I am otherwise healthy, have an undetectable viral load, and have never been exposed to chicken pox. Wouldn't a chicken pox infection cause a greater viremia than the vaccine? Please help me to understand this.

Thank you

Although you can't recall having been exposed to chicken pox, you may have had a 'silent' (subclinical) case. Ask your doctor to do a VZV IgG blood test -- you may already be immune to chicken pox.

Besides the issue of a transient increase in HIV viral load from the stimulation of a vaccine, the real issue here is that the vaccine is a live attenuated (weakened) virus. These kinds of vaccines should not be given to people with immune deficiencies because a generalized infection from the vaccine itself could develop. So I'd advise you not to do it.

If you aren't immune and subsequently get exposed to chicken pox, you can be given Varicella immune globulin, which is a passive form of immunization.