Which vaccine listed is a live attenuated vaccine that should be avoided in severely immunocompromised adults with HIV?

• A. Inactivated influenza vaccine
• B. Hepatitis B vaccine (recombinant)
• C. Pneumococcal conjugate vaccine
• D. MMR vaccine (measles, mumps, rubella)

Answer: (D)

Live attenuated vaccines contain weakened pathogens that can replicate in the body. In adults with HIV who are severely immunocompromised, this replication can overwhelm the impaired immune system and cause actual infection from the vaccine strain. The measles-mumps-rubella (MMR) vaccine is a live attenuated vaccine, so it should be avoided in this group.

The other options are not live vaccines. The inactivated influenza vaccine is the non-live form of flu vaccine and is safe and recommended for people with HIV. The recombinant hepatitis B vaccine and the pneumococcal conjugate vaccine are non-live subunit/conjugate vaccines and are also appropriate for individuals with HIV.