HIV Providers Identify Lack of Knowledge and Clear Guidelines Among Barriers to Herpes Zoster Vaccination in HIV-Positive Adults

Background: In 2008, The CDC released guidelines for Herpes Zoster (HZ) vaccine in adults, including HIV-positive patients.

Objectives:  Identification of perceptions about HZ disease, vaccine effectiveness and safety, and vaccine recommendations may impact immunization practices in HIV-positive patients.

Methods: A survey was emailed to 1700 providers who subscribed to a national HIV listserve. Providers were queried about their practice type, vaccination practices for routine immunizations, HZ vaccine, knowledge about HZ in HIV-positive pts, and barriers to HZ vaccination.

Results: There were 272 respondents (16%). Most providers (89%) offered routine vaccinations. Correct answers for the incidence of Varicella Zoster virus (VZV) infection in adults and incidence of HZ in HIV-positive patients were recorded by 14% and 10% of providers. Providers reported poor knowledge of the incidence of disease recurrence (41% correct), potency of HZ vaccine (47.5% correct), and mechanism of protection against reactivation of VZV (66% correct). Most (88%) providers agreed that HZ was a serious disease, and 73% believed that the burden of disease made vaccination important. A majority (75%) did not vaccinate HIV patients with HZ vaccine regardless of antiretroviral therapy. Major barriers to administration included safety concerns, concern that vaccine would not prevent HZ, risk of HZ dissemination, reimbursement issues, and lack of guidelines. Only 38 % of providers agreed that CDC guidelines were clear and 50% believed that clinical trials were needed prior to use of HZ vaccine in HIV patients.

Conclusions: Education about HZ is needed among providers. Providers perceived that while the burden of disease and its complications in HIV-positive patients make vaccination important, the data on vaccine safety and clear guidance from the CDC on this issue is lacking. Clinical studies evaluating the effectiveness and safety of HZ vaccine in HIV-infected adults may be useful to change HZ immunization practices among HIV providers.