A 25-year-old man comes to the office due to a positive home HIV test. The patient's partner was recently hospitalized with Pneumocystis pneumonia, which prompted the patient to get tested. He has no chronic medical conditions and takes no medications. He smokes a pack of cigarettes daily and uses intravenous heroin. The patient received all recommended childhood vaccinations through age 18. Vital signs are normal. Physical examination reveals no abnormalities. Laboratory results are as follows:
Which of the following immunizations are recommended for this patient?

Question

A 25-year-old man comes to the office due to a positive home HIV test.  The patient's partner was recently hospitalized with Pneumocystis pneumonia, which prompted the patient to get tested.  He has no chronic medical conditions and takes no medications.  He smokes a pack of cigarettes daily and uses intravenous heroin.  The patient received all recommended childhood vaccinations through age 18.  Vital signs are normal.  Physical examination reveals no abnormalities.  Laboratory results are as follows: 
Which of the following immunizations are recommended for this patient?

Quizplus · Accepted Answer

Explanation: 11ec25c8_d27c_be4a_bc81_fb460a6a0b81_MD0003_00 As with all adults, patients with HIV should receive vaccination for influenza annually in the fall (but with the inactivated formulation rather than the live attenuated or nasal formulations). They should also receive vaccination against the following pathogens due to elevated risk of infection or sequalae: Hepatitis A - vaccination should be administered to those with no serologic evidence of immunity. Hepatitis B - vaccination should be administered unless there is evidence of immunity (as in this patient with positive hepatitis B surface antibody and negative core/surface antigen) or active infection. Streptococcus pneumoniae - the 13-valent pneumococcal conjugate vaccine (PCV13) should be administered, followed by the 23-valent pneumococcal polysaccharide vaccine (PPSV23) 8 weeks later and again in 5 years and at age 65. Zoster - vaccination should generally be administered to those born after 1979 who have no evidence of immunity (as in this patient with negative anti-varicella IgG). The recombinant (inactivated) vaccine can be given to patients with CD4 counts <200/mm³ but the immunogenic response is often muted; therefore, it is frequently delayed until CD4 counts are improved following antiretroviral therapy initiation. Meningococcus - vaccination should be given to all patients with HIV and booster should be administered every 5 years. Patients with HIV are also generally given revaccination for tetanus and diphtheria (Td) every 10 years; a single dose of tetanus-diphtheria-acellular pertussis (Tdap) is sometimes considered to address waning pertussis immunity, particularly in those who have not previously received Tdap. Educational objective: All adults should receive annual vaccination for influenza, as well as a single dose of tetanus-diphtheria-acellular pertussis, with revaccination for tetanus and diphtheria every 10 years. In addition, all patients with HIV should receive vaccinations for hepatitis A, hepatitis B, and zoster (unless they have documented immunity); immunization for Meningococcus and Streptococcus pneumoniae should also be given. References: Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. (http://www.ncbi.nlm.nih.gov/pubmed/19357635) Vaccination in HIV-infected adults. (http://www.ncbi.nlm.nih.gov/pubmed/25029589)

A 25-Year-Old Man Comes to the Office Due to a Positive