Dear Alice,

I'm HIV positive, very low viral load & great t-cell count (not on meds). I've been reading recently that flu shots aren't all they're cracked up to be. What are the dangers of a flu shot, and if my immune system is already doing well, should I still get a flu shot?

Dear Reader,

The Centers for Disease Control and Prevention (CDC) recommend that most people be vaccinated with the yearly flu shot. This includes people who are HIV positive; in fact, HIV positive folks usually get high priority in the case of a vaccine shortage.

The inactivated influenza vaccine, commonly called the flu shot, is recommended for people with underlying chronic medical conditions, including HIV. Because people with HIV are at an elevated risk for influenza-related complications due to a weakened autoimmune system, getting the flu shot is advised for most HIV-positive people. Getting a flu shot may temporarily increase your viral load as your immune system responds, but viral load is transient and usually returns to baseline within four weeks. Some of the reasons not to get the inactivated flu shot are the same for people with and without HIV include: a history of severe allergy to hens' eggs or a history of onset Gullain-Barre syndrome following a vaccination (if you have a history of these, you likely already know).

While the inactivated influenza vaccine (the shot) is recommended, people with HIV/AIDS are not recommended to receive the live influenza virus vaccine, called FluMist. FluMist is a mist administered through nasal passageways and contains a weakened form of the live flu virus. Because it contains weakened, but still live, virus, it can compromise the immune systems of those living with HIV, even if they are currently quite healthy. Anyone with suppressed or compromised immune systems, pregnant women, and those with chronic illness should also avoid FluMist.

During flu season, it will be paramount to keep an eye on your surroundings. If you are likely to come in direct contact with someone with the flu, either through casual contact or in occupational settings, antiviral medications may help prevent the flu infection. Chemoprophylaxis, or "chemical prevention," can be taken for up to seven days to prevent getting the flu if you have high exposures to other people with influenza. There are no published data on any dangerous interactions between anti-influenza chemoprophylaxis and drugs normally used in the management of HIV.

Even though a decision to receive a flu shot may feel somewhat routine, it is always a good idea to check with your health care provider before receiving the shot. Your health care provider can discuss your options with you, and schedule a flu shot if necessary.

You can help keep your immune system as healthy as possible by eating well, getting rest, and washing your hands frequently. These prevention efforts are recommended for everyone and may help you stave off the flu, regardless of whether you opted for the flu shot.


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