Documents

Shingles remains a significant cause of morbidity in people living with HIV despite advances in antiretroviral therapy. The recombinant zoster vaccine (RZV) is recommended for this population, yet vaccine coverage and adherence remain suboptimal. This study evaluated the implementation, coverage, and determinants of varicella-zoster virus vaccination in a Spanish cohort of HIV patients.

We retrospectively analyzed adults with chronic HIV infection followed at an infectious diseases unit in Alicante from January 2022 to March 2025. Sociodemographic, clinical, and vaccination data were extracted from electronic health records. Vaccination status was classified as complete, partial, or unvaccinated. Factors associated with full vaccination were assessed using multivariate analysis.

Among 198 eligible patients, 37.4% completed the full vaccination schedule, 4% were partially vaccinated, and 46% remained unvaccinated. Primary reasons for incomplete vaccination included lack of referral and loss to follow-up. Referral to preventive medicine services and attendance at scheduled appointments were the strongest independent predictors of completing vaccination. No significant associations were observed with age, sex, CD4 + counts, viral load, or comorbidity burden.

Although vaccination coverage has improved compared to previous reports, significant gaps persist among people living with HIV in our clinic setting. These gaps are mainly due to systemic barriers in patient referral and retention within the vaccination program. Targeted interventions are needed to optimize vaccination pathways, enhance patient follow-up, and strengthen coordination between healthcare providers and patients to increase full immunization rates and reduce shingles-related morbidity in this vulnerable population.