Dear Dr. Roach: I am a 58-year-old male who has never had chickenpox. Ten years ago, after bloodwork to confirm no exposure to chickenpox, my doctor gave me the required two sets of the chickenpox vaccine in order to build immunity.
My question is this: Since you can get shingles only if you have had chickenpox in the past, should I consider getting the new Shingrix vaccine? Or would this be a waste of money? I also should say that I am HIV positive for 22 years with no symptoms, and no opportunistic infections. B.D.
Answer: Unfortunately, people who have not had chickenpox but who have had the varicella vaccine (the live vaccine usually given to children to prevent chickenpox) still may get shingles. The risk is low: For every 50 people given the varicella vaccine, about one person will get shingles in 20 years. However, the risk in someone with HIV infection would be expected to be somewhat higher, even in someone who has been as well-controlled as you have.
You definitely should consider the Shingrix vaccine. Whether its a waste of money is hard to say. It reduces your risk of shingles from fairly small to very small. You, personally, have possibly less risk because you had the weakened vaccine strain of chickenpox rather than natural or wild-type chickenpox, but then you have a slightly higher risk due to your HIV infection. The downside of getting it is a sore arm (less likely is a more severe reaction) and some money (though most insurances cover it in the U.S.). The upside is that youd have a lower risk of getting shingles, which is painful and unpleasant, and which in the rare case can cause serious disease. You also reduce your risk of post-herpetic neuralgia, a potentially devastating complication that lasts weeks to months (sometimes years) and dramatically reduces quality of life.
