For a patient with HIV presenting with a CD4 count of 150 cells/mcL, which vaccination is contraindicated?

In a patient with HIV and a CD4 count of 150 cells/mcL, the administration of the Measles, Mumps, and Rubella (MMR) vaccine is contraindicated. This is primarily because the MMR vaccine is a live attenuated vaccine, which means it contains live viruses that have been weakened but can still potentially cause disease in individuals with significant immunosuppression, such as those with a low CD4 count.

In individuals with a CD4 count below 200 cells/mcL, like this patient, the risk of progression to disease from a live vaccine outweighs the benefits, making it unsafe to administer. Immunocompromised individuals are at an increased risk for adverse effects from live vaccines, which can lead to serious complications. Therefore, the MMR vaccine should be avoided in this population until their immune status improves.

In contrast, inactivated vaccines, such as the flu vaccine, hepatitis B vaccine, and pneumococcal vaccine, are generally safe and recommended for immunocompromised patients, as they do not pose the same risk of causing disease. These vaccines can provide protective immunity without the risk associated with live attenuated vaccines.