Recombinant Herpes Zoster Vaccine Recommendations

Safety and Efficacy

The Centers for Disease Control and Prevention recommends the recombinant herpes zoster vaccine (Shingrix) for immunocompromised patients, including those with HIV and low CD4 counts, as it is a non-live vaccine and safe for this population 1
Shingrix demonstrates 97.2% efficacy in preventing herpes zoster in adults aged 50 years and older, with protection persisting for at least 8 years and maintaining efficacy above 83.3% 1
The American College of Immunology recommends Shingrix for all adults aged 50 years and older, regardless of prior chickenpox history, due to its high efficacy and safety profile 2

The recombinant zoster vaccine is recommended for immunocompromised adults aged ≥18 years, with a shortened dosing schedule of 1-2 months between doses 1
The minimum interval between doses is 4 weeks, and the vaccine can be administered regardless of current antiretroviral therapy status 1

Varicella vaccination is only considered for HIV-infected persons who are VZV-seronegative, and even then, a CD4 count of >200 cells/mm³ is required for safe administration of this live vaccine 3, 4, 5
Live vaccines like varicella are generally avoided in immunocompromised patients, making Shingrix a preferred option 6

Common side effects of Shingrix include injection-site reactions (9.5% of recipients) and systemic symptoms (11.4% of vaccine recipients) 1
No serious safety concerns have been identified in large clinical trials, and the vaccine maintains effectiveness even in patients on immunosuppressive therapy 1