Patients with acquired immunocompromising conditions face considerable risk of developing herpes zoster (HZ). Based on the underlying medical conditions and degree of immune dysfunction, these patients require tailored strategies for HZ prevention. In Hong Kong, there is currently a lack of guidelines addressing the unique needs of this vulnerable population, including the use of prophylactic measures such as antivirals and vaccines. An expert panel comprising clinical immunologists, nephrologists, infectious diseases specialists, rheumatologists, hematologists and oncologists in Hong Kong met to review current literature and international guidelines to propose a locally adapted decision-making framework for HZ prophylaxis, in patients with acquired immunocompromised conditions. This article summarizes the consensus and presents a guiding criteria for clinicians to navigate the complexities associated with HZ prevention, in the context of acquired immunodeficiency.