Disseminated vaccine-strain varicella as initial presentation of the acquired immunodeficiency syndrome: A case report and review of the literature

Immunization of HIV-infected adult patients — French recommendations

“…93 Two cases of vaccine-associated varicella with visceral involvement were reported in one HIVinfected child and one adult with undiagnosed HIV infection at the time of vaccination. 94 The potential seriousness of varicella in HIV-infected adults highlighted in a case reporting a fulminant evolution underline the usefulness of the varicella vaccine. 95 Vaccination against varicella is recommended in HIV-infected adolescents and adults who have no history of varicella and who are none immune.…”

British HIV Association Guidelines on the Use of Vaccines in HIV‐Positive Adults 2015

“…HIV‐positive patients who acquire chickenpox are at increased risk of severe and even fulminant disease . Cell‐mediated immunity plays a major role in controlling VZV reactivation, and impaired cellular immunity also increases the risk of shingles in people with HIV .…”

Vaccinations for the HIV-Infected Adult: A Review of the Current Recommendations, Part II

“…Live vaccinations are generally avoided among HIV-infected persons if an inactivated form of the vaccine is available (e.g., influenza, polio, and typhoid). The reason for avoiding live vaccines among immunosuppressed persons is the concern for possible viral or bacterial replication post-vaccination and subsequent infection by the vaccine strain [ 10 , 11 ]. When only live vaccines are available for prevention of an infectious agent, some live vaccines (e.g., varicella, zoster, MMR) may be considered if the level of immunosuppression is low (CD4 count >200 cells/mm 3 ) [ 6 ].…”

“…Specifically, vaccination can be considered among non-immune, clinically stable patients with a CD4 count >200 cells/mm 3 (CD4% >15%). For persons with more severe immunosuppression, vaccination is not recommended due to the risk for disseminated disease due to the live vaccine strain [ 10 , 11 ].…”