Which vaccine is contraindicated for an adult patient with HIV and a CD4 count less than 200 mm2?

The measles, mumps, and rubella (MMR) vaccine is contraindicated for adult patients with HIV and a CD4 count of less than 200 mm² because it is a live attenuated vaccine. In individuals with significantly compromised immune systems, such as those with advanced HIV or low CD4 counts, live vaccines pose a risk. The immune response may be insufficient to safely handle the attenuated viruses, and there is a potential risk for the vaccine to cause disease rather than prevent it.

In contrast, other vaccines listed, like the inactivated influenza vaccine, human papillomavirus vaccine, and recombinant zoster vaccine, are either inactivated or non-live and can be safely administered even to individuals with compromised immunity. The inactivated influenza vaccine is safe and recommended for everyone, including those with HIV. The HPV vaccine is beneficial for HIV-infected individuals for cancer prevention. The recombinant zoster vaccine is also recommended for those with moderate immune compromise, meaning CD4 counts above specific thresholds.