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Twinrix: This product may be used to simultaneously immunize HIVinfected patients for HAV and HBV using a 0, 1 and 6 month schedule (MMWR 2001;50:806). Studies in 2,165 healthy adults showed antigenic response to the HAV component in 99.9% and the HBV component in 98.5%.
Hepatitis C preventive treatment
INDICATION : Acute HCV infection defined as ≤6 months from time of HCV exposure. Goal is to prevent chronic HCV infection.
PREFERRED: Peg-interferon in standard dose x 24 weeks (Gastroenterology 2006;130:632).
Note: Ribavirin is not required due to high rates of cure with Peg-interferon.
Influenza vaccine
INDICATION: All patients annually.
PREFERRED: Influenza vaccine 0.5 mL IM each year, preferably in October to November. A trial in 2002-2003 showed a good humoral immune response even with low CD4 counts (JAIDS 2005;39:167). A review of 6 published reports showed vaccine effectiveness rates of 27-78% (BMC Infect Dis 2006;11:138).
Human Papillomavirus vaccine
INDICATION: Women aged 15-24 yrs.
PREFERRED: HPV quadravalent vaccine 0.5 mL IM at 0, 2 and 6 mo.
Histoplasmosis prevention
INDICATION: CD4 count <150 cells/mm3and at high risk because of occupational exposure or residence in a community with a hyperendemic rate of histoplasmosis defined as >10 cases /100 person years.
RISK: For patients with a CD4 count <100 cells/mm3who live in the Midwest or Puerto Rico and are not taking HAART, the risk is 2-5% (CID 2000;30:50).
RECOMMENDATION: Consider primary prophylaxis if CD4 <150 cells/mm3 and residence in endemic area or occupational risk.
PREFERRED: Itraconazole 200 mg/day po.
Coccidioidomycosis prevention
INDICATION: Consider annual serology for C. immitis for patients with CD4 counts <250/mm3 and residence in an endemic area. Indication for prophylaxis is positive serology (lgM or IgG).
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