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Flu shots and AIDS/HIV
Aug 21, 1996

Is there a definitive answer on whether people with AIDS and/or HIV should take flu shots?

Response from Dr. Cohen

There are several studies looking at this question that give conflicting answers. Some studies say that the flu shot causes a temporary increase in viral load. Other studies suggest that it does not. Here are the pros and cons of getting the flu shot:

PROS:

Unless you have very advanced HIV infection, it will probably prevent the flu and all its associated miseries. Some people can develop bacterial pneumonia as a complication of the flu, and people with HIV infection are at greater risk of developing bacterial pneumonia. If the flu shot does increase viral load, it is very temporary, and may not happen at all if you're on effective antiretroviral therapy. For all we know, getting the flu itself may cause a much greater increase in viral load than getting a flu shot. Preventing flu may be a good idea because some of the symptoms of the flu could be mistaken for more serious opportunistic infections, such as PCP, leading to unnecessary diagnostic tests or treatment.

CONS:

There may be a transient increase in viral load associated with the flu shot, which could theoretically lead to a decline the CD4 cell count. If you have advanced HIV disease with low T-cells, the flu shot is unlikely to work, anyway. Most HIV-infected individuals who get the flu get over it just like everybody else.

So you have to decide for yourself. I explain these things to my patients, and offer the flu shot as an option for those with reasonable CD4 cell counts. For those with low CD4 cell counts, I usually don't bother, as their response to vaccines is usually poor.



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