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flu shots and Tamiflu
Oct 15, 2005

October 14th, 2005

How quickly will those of us with diminished abilities to defeat INFLUENZA, the regular down and hacky type...g-d forbid AVIAN FLU, be availed the opportunity to acquire prophylactic treatments such as Tami-flu, etc.? Also, are this seasons FLU VACCINES available immediately?

I have recently recovered 225 T4-Cells, up from 140-6 weeks on anti-retro-viral treatment and wonder if I can be vaccinated immediately and if any special vaccinations are available to the immune compromised?

Your friend and patient, CC, Boulder, CO

Response from Dr. Young

CC- Great to hear from you. I hope that you're well.

Thanks for your question; influenzas have certainly been getting a lot of attention in recent weeks-- what with influenza vaccinations, avian (bird) flu and now canine (dog) flu in the press.

First off, as you're aware (because I always tell you), the regular hacky "flu" probably isn't influenza A. The former is likely a common cold (or perhaps other respiratory viruses, like parainfluenza or influenza B), but is not associated with significant mortality. That's certainly not to say that they can make you miserable.

Influenza A on the other hand is the thing that should be of concern to all people- it's associated with tens (yes tens) of thousands of deaths in the US alone- every year; to say nothing of the severe illness and loss of productivity that it inflicts on the thousands that get it and survive. This is the stuff of our annual flu vaccinations, and to a large extent, the target of the medications, Tamiflu and Relenza. Indeed, for our patients with HIV who develop influenza A (or B), Tamiflu has been used in the past with good results in diminishing the severity and duration of symptoms, as you're aware.

To our surprise, there's very little that suggests that persons with HIV are at greater risk of severe influenza than the general population, despite the very real and measurable decreases in immunity (CD4 cells). The efficicacy of the influenza vaccination in patients with very low CD4s is probably impaired, but this shouldn't prevent one from seeking a potentially life-saving vaccine (it's safe whether it works or not).

Avian flu is of concern because of the potential that the bug will jump from human to human. (Such now appears to be the case in the 1917 pandemic.) While this worries many in public office, the general public should bear in mind that there have been only ~100 human cases and ~60 deaths-- mostly in Asia, where 1.5 billion persons are potentially at risk. I balance the tragedy of these 60 deaths with the known risks of tens of thousands of (largely preventable) flu A deaths or the 3000 daily deaths (world wide) from AIDS. These are the things that keep me up at night, not avian flu.

Lastly, this year's flu vaccine is now (Oct 14) widely available. Give us a ring, we can get you your's if you'd like.

Thanks for posting. See you soon. BY



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