Oct 20, 2010
My cd4 count is 81 and my viral load is undetectable. I asked my doctor if it is okay for me to receive the flu shots, pneumonia shots, hepatits A and B, and meningitis shot. He said becuase my cd4 count is low it would not be beneficial to me. Most people at work have been sick lately, I am very concerned I will catch something that will make me ill. I am on Isentress and Truvada, Dapsone, Diflucan, and Azithroymcin and Valtrex for hsv-2.
Please advise on any recommendations you may have. Should I seek a second opinion.
Response from Dr. Young
Hello and thanks for your post.
Your doctor is correct in that with low CD4 counts, your response to vaccinations might be impaired. Experts differ on exactly when is best to vaccinate people in your situation, understanding that your health and CD4 are likely to improve in the months to come.
The way that I look at this is to examine what things might pose the most immediate health risks and vaccinate for these first, understanding that you might optimally need a booster vaccination later. In this regard, influenza and Pneumococcal pneumonia are significant risks-- I typically vaccinate for these independent of CD4 count. By contrast, hepatitis A and B vaccines can probably be deferred; I usually wait until the CD4 is above 200 before offering these (though stress the need for safe sex/drugs and food to decrease the risk of getting hepatitis). Meningitis vaccination is optional.
I hope this is helpful, BY
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