Dr. McGowan,

I recently asked a question about when to start meds. My numbers have been really good, so I'm not on meds. CD-4 was 800 last checked and VL 6,000. From all the info I've gotten, when to start is a personal decision. Because I know you guys get lots of questions and are busy with your own practices, I was not going to ask another question for a while. But...

I was watching "60 Minutes" tonight. They did a story on H1N1 and how it is affecting young people more. They profiled a high school student who was very ill in the hospital with it. He also had a staph infection. Even now, he is in bad shape. He developed a really bad strep pneumonia--which I understand happens a lot with this flu. This boy was the model of health. He is an athlete.

Do we know yet how H1N1 is affecting HIVers? Whenever they say on the news who is getting sickest, they always say people with asthma, pregnant women, and immune compromised people. I suppose they mean HIVers when they use that term, or people going through cancer treatment.

I've been so worried about this flu, because I'm not on meds yet and because I was diagnosed last year after getting strep pneumonia from a mild flu. Before that, I couldn't tell you the last time I was sick. I just never got sick.

I'm wondering if medical evidence shows I would be more likely to get the pneumonia again, since I had it before? I got the pneumonia vaccine; however, I've read it doesn't really keep you from getting it, but may make the illness less severe. On the other hand, would I have built up any immunity to strep pneumonia? Do people who've had pneumonia usually have damage to their lungs? Mine was just in one lung.

Watching the news has really scared me about this flu. My doc believes it may be late November before the injectable vaccine is in. It all makes me want to stay in and avoid people. With the holidays coming up, this will be hard to do. Should I be so worried? I guess one good thing came out of learning I was poz--I quit smoking last year. I know smoking makes ya more likely to get flu and pneumonia.

Thanks again for all you do. I apologize for the long question. I think all our docs should offer their e-mail addresses, so we can ask them questions in between visits.

Thanks for your very timely question.

H1N1 flu is a "new" virus that most people (especially younger people) have not had any exposure. That means that the immune system has not had the chance to respond to this bug yet. New infections are always the most challenging for the immune system since it has to make up a reaction from scratch. That is why a vaccine can already prime the immune system and give you the head start in case you get exposed.

As you pointed out most of the bad outcomes from H1N1 have been in people who have developed bacterial pneumonia, so having gotten the pneumococcal vaccine is a good thing. and stopping smoking is also very good.

You should get both the "regular" (seasonal vaccine), as well as H1N1. Until the shot is available the best thing to do is wash your hands frquently, especially after being out in public and before eating. Try to avoid putting your hand to your face/mouth until after washing. Use an "elbow bump" in place of a handshake to greet people...it is all the rage now!

Best, Joe