My patient already has advanced HIV disease, is it too late to vaccinate with Shingrix recombinant zoster vaccine (RZV)?

No. Antiretroviral treatment for HIV may improve immune response to vaccination; however, zoster vaccination with Shingrix does not have to be delayed in order to achieve viral suppression, especially if this will significantly delay vaccine administration. Patients with advanced HIV should receive Shingrix, because the risk of shingles is further increased in the setting of such immune compromise.