If an HIV patient has a CD4 count less than 200, how can they be protected against varicella?

• A. Administer varicella vaccine
• B. Give immunoglobulin if exposed
• C. Prescribe antiviral medication
• D. Use prophylactic antibiotics

Answer: (B)

Individuals with HIV and a CD4 count less than 200 cells/mm³ are significantly immunocompromised, which places them at a higher risk for infections, including varicella (chickenpox). In such cases, vaccination is not considered safe or effective for adults with a severely weakened immune system, due to the potential risk of a vaccine-related illness.

When these patients are exposed to varicella, the administration of varicella zoster immunoglobulin (VZIG) can provide passive immunity. VZIG can help prevent or mitigate the severity of varicella in individuals who are not immune and have been exposed to the virus. This passive immunization is particularly important for immunocompromised patients, as they may not mount a sufficient immune response to infection or vaccination.

While antiviral medications can be used to treat varicella in patients who develop the disease, they do not prevent the infection post-exposure. Prophylactic antibiotics are not relevant in the context of varicella exposure and are not a standard approach for preventing viral infections like varicella-zoster. Thus, offering immunoglobulin to an exposed HIV patient with CD4 counts below the threshold is the most appropriate preventive measure.