This patient should receive the 13-valent pneumococcal conjugate vaccine (PCV13) now. Vaccination against Streptococcus pneumoniae is indicated in all persons with HIV infection because of the increased risk of invasive pneumococcal disease. Immunocompromised persons, including those with HIV, should receive PCV13 first, followed by the 23-valent pneumococcal polysaccharide vaccine (PPSV23) at least 8 weeks later, in a “prime-boost” strategy that is used to improve the antibody response to immunization. This recommendation applies regardless of the patient's CD4 cell count.

HIV infection alone is not an indication to receive hepatitis A vaccination. Hepatitis A vaccination would be indicated if the patient had another risk factor, such as men who have sex with men or other liver disease, including chronic hepatitis B or C virus infection. She does not have hepatitis B or C virus infection, as shown by negative results on laboratory testing, so hepatitis A vaccination is unnecessary at this time.

All patients with HIV should be vaccinated for hepatitis B if not already immune or infected. However, this patient has positivity for hepatitis B surface antibody, demonstrating existing immunity. Therefore, she does not require hepatitis B immunization.

This patient is beyond the recommended age (approximately 11-26 years) for females in the general population to receive human papillomavirus vaccination. This recommendation does not change for patients with HIV infection.

This patient should receive PPSV23, but not until at least 8 weeks after PCV13, so giving it now would be inappropriate. Patients with HIV infection who have received PPSV23 in the past should receive PCV13 followed by another PPSV23 dose at least 8 weeks later.