There are two kinds of live vaccines against the varicella-zoster virus. One vaccine, called Varivax is typically recommended for children and guards against initial infection and chickenpox. The other vaccine, called Zostavax, is is used to protect a person from developing shingles.
The Varivax vaccine is recommended for HIV-positive children who've never had chicken pox, are at least eight years old, and have a CD4 count of at least 200. While there haven't been any studies testing the safety and effectiveness of Varivax in HIV-positive adolescents and adults who've never had chicken pox, many expert groups recommend it for older HIV-positive people, provided that their CD4 count is at least 200. If the vaccine ends up causing disease—a possibility when live vaccines are used—treatment with acyclovir is recommended.
Zostavax, the vaccine to prevent shingles in people who have already had chickenpox, is not currently recommended for HIV positive adults. This is because it is more potent than Varivax and may cause more extensive side effects, including severe rash and disseminated disease, in people with compromised immune systems. Zostavax has not yet been fully evaluated in people with compromised immune systems, including people with HIV. It is probably best that the vaccine be avoided by all HIV-positive people, regardless of their immune system status, until necessary clinical trials are completed.
At the present time, keeping the immune system healthy is the best way to prevent shingles. This means keeping your viral load low and your CD4 cells high using anti-HIV drug treatment and by adopting a healthy lifestyle.
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