My patient is age 34 years and has well-controlled HIV infection, but no history of varicella vaccination, chickenpox, or shingles. Do I need to have proof of a history of varicella disease or vaccination before I vaccinate with Shingrix?

Immunocompromised adults age 19 years and older without evidence of exposure to live varicella virus through a history of chickenpox, zoster, or documentation of vaccination with live varicella vaccine (Varivax or ProQuad, Merck) or zoster vaccine live (Zostavax, Merck) should be evaluated further for their risk of zoster before receiving Shingrix. Birth before 1980 is not sufficient proof of a history of primary varicella infection (chickenpox) for immunocompromised adults.

Vaccination with varicella vaccine to prevent chickenpox may be considered for a patient with well-controlled HIV (e.g., CD4+ T-lymphocyte percentage of at least 15% and a count of at least 200 cells per microliter) and no evidence of a history of varicella disease or vaccination. Vaccination may be considered for a patient who has a CD4 count of at least 200 cells per microliter but no information on percentage. Vaccination is contraindicated if a patient has laboratory information on the CD4 percentage and/or count and either measure falls below the recommended acceptable threshold for vaccination.

For other situations involving immunocompromised adults with no evidence of a history of varicella disease or vaccination, see detailed guidance provided by CDC at www.cdc.gov/shingles/vaccination/immunocompromised-adults.html#special-populations.