Varicella vaccine has been demonstrated to be safe and immunogenic in children with HIV infection with minimal symptoms and CD4 cell percentages according to their age of 25% or more. A study evaluated the safety and eﬃcacy of varicella vaccine in children with either moderate symptoms and CD4 cell percentages more than 15%, or a history of severe immunosuppression who had achieved immune reconstitution. Regardless of immunological category, 79% of vaccine recipients with HIV infection developed VZV-speciﬁc antibody or cell-mediated immunity, or both, 60 days after the immunisation series. The current recommendations from the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention states that single-antigen varicella vaccine should be administered to children with HIV infection with a CD4 T lymphocyte percentage greater than 15%, whereas the Australian guidelines currently recommend vaccination at greater than 25%.,, The ACIP also recommend that single-antigen varicella vaccine may be considered in VZV-seronegative adolescents or adults with HIV infection with a CD4 cell count greater than 200 cells/μL. Two doses should be administered 3 months apart., A recent review reported the use of live-attenuated HZ vaccine in adults with HIV infection with a CD4 cell count over 200 cells/µL with immunogenic response, a good safety profile and no cases of vaccine strain infection.
Zoster immunoglobulin is indicated for patients with HIV infection within 96 hours of signiﬁcant ﬁrst VZV exposure (e.g. household or classroom contact), and protection may last for approximately 3 weeks or alternatively a thymidine kinase inhibitor (acyclovir) can be given up to 7 days post exposure.
In terms of prevention of HZ recurrences, one study found that the use of oral acyclovir among patients with HIV infection at a dose of 400 mg twice daily decreases the risk of HZ recurrence by 62%, although this result has not been repeated.