Do you recommend the Shingles Vaccine?
Dec 20, 2012
I am a 60 white male who has been positive since 1998. I am currently taking Atripla with decent results. My viral load is undetectable but I have never had a high t-cell count. My last labs showed 288 at 15%. My Dr. is OK with me getting the Zostavax vaccine if I want it. I would like a second opinion from you. Thank you for your great service to the community, this site has been a tremendous resource for me during the last 14 years.
Response from Dr. McGowan
Thanks for your question.
Zoster can occur in anyone who has previously had checken pox (Varicella). Of course people with HIV may be at higher risk for occurance (and it may happen more than once). First thing would be to be sure you have had chicken pox. Most people who have grown up in the US have had chicken pox even if they do not recall a rash. People from warmer climates, for example the Caribbean, may never have had it. A blood test can be done if you are unsure.
The Zoster vaccine contains a live (but weakened) virus, so it may theoretically lead to side effects if the viral levels are not controlled adequately by the immune system. The Zoster vaccine contains a high level of virus, 14 times more than the chicken pox (Varicella) vaccine. So the risk may be higher.
There has been one study with preliminary (early) data reported so far on using zoster vaccine in people with HIV. All people vaccinated had CD4 counts over 200 and the vaccine was generally safe (there were some injection site reactions) and effective in stimulating antibodies to go up. There is currently no recommendation to use the vaccine in people with HIV, but these data are very encouraging. Hopefully further supporting data will be coming out in the near future. The main risk would be that a disseminated infection may occur. If a person with HIV develops a rash or signs of widespread infection after reciving zoster vaccine, they should be promptly seen by their doctor and may need to be treated with medication for zoster.
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