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. More specifically, getting the inactivated influenza vaccine, a.k.a. the flu shot, is advised for people with underlying chronic medical conditions and those who are human immunodeficiency virus (HIV) positive; in fact, HIV positive folks usually get high priority in the case of a vaccine shortage. Because people with HIV are at an elevated risk for influenza-related complications due to a weakened autoimmune system, getting the flu shot is typically advised. Getting a flu shot may temporarily increase your viral load as your immune system responds, but soon thereafter it usually returns to baseline. 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 Guillain-Barre syndrome following a vaccination.

While the inactivated influenza vaccine (the shot) is recommended, people with HIV are not recommended to receive the live attenuated influenza vaccine (LAIV), 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 may compromise the immune systems of those living with HIV, even if they're currently quite healthy. FluMist isn't recommended for anyone with suppressed or compromised immune systems, pregnant women, and those with chronic illness at this time.

During flu season, it'll be paramount to keep an eye on your surroundings. If you're 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 is 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's always wise to check with your health care provider before receiving the shot. They can discuss your options with you, and schedule a flu shot if necessary. Additionally, 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.

Alice!

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