Flu & People Living with HIV

Man with red ribbon for the fight against AIDS

People with HIV are at higher risk of serious influenza-related complications.

Human immunodeficiency virus (HIV) is the virus that can lead to acquired immunodeficiency syndrome (AIDS). HIV attacks cells in the body’s immune system called CD4 cells and, if untreated, gradually destroys the body’s ability to fight infection and certain cancers. CDC estimates that nearly 1.2 million people in the United States 13 years and older were living with HIV at the end of 2019, the most recent year for which this information is available.

People living with HIV (PWH) are at higher risk of developing serious flu-related complications, especially those who have a very low CD4 cell count (very suppressed immune system) or who are not taking medicine to treat HIV (called antiretroviral therapy, or ART). Of all PWH in the United States from 2018-19, 81% were prescribed ART, leaving nearly 20% especially vulnerable to flu complications. Studies have indicated that flu symptoms might be prolonged and the risk of flu-related complications and prolonged flu virus shedding is higher for certain people living with HIV.

Because they are at higher risk of serious flu-related complications, it is especially important that PWH get a flu shot annually. PWH who are not receiving ART might not have as strong an immune response to vaccination as those who are receiving ART. PWH who get flu symptoms, especially those with low CD4 cell counts not receiving ART, should be treated with influenza antiviral drugs right away.

This page addresses recommendations related to flu shots for PWH and the use of influenza antiviral drugs in this group.

Image Promotion: Make a statement this season. If you have HIV or AIDs, get a flu shot.

A Flu Shot is the Best Protection Against Flu

If you have HIV, you are at higher risk of developing serious flu-related complications, in addition to taking ART, the best way to prevent flu is by getting a flu shot.

  • Several randomized studies in adults living with HIV have shown that flu vaccination can reduce the risk of flu illness. Studies in the United States have shown that flu vaccination prevents illness and reduces the need for doctor’s visits among PWH and other conditions resulting in immune suppression.
  • People living with HIV should get a flu shot (not the nasal spray flu vaccine) every year. Injectable flu vaccines (or flu shots) are approved for use in PWH and other health conditions. Live Attenuated Influenza Vaccine [LAIV] (nasal spray) vaccine should not be used in people with HIV and AIDS. LAIV (FluMist®) contains a weakened form of the live influenza virus and is not recommended for use in people with weakened immune systems (immunosuppression).

Note: While PWH may still mount an immune response to flu vaccination, people with advanced HIV disease may not respond as well. Doctors may consider using influenza antiviral drugs for prevention in some cases. Visit the Summary for Clinicians: Chemoprophylaxis page for more information.)

Get pneumococcal vaccines

  • Pneumococcal pneumonia is an example of a serious flu-related complication that can cause death.
  • PWH should also be up to date with pneumococcal vaccination to protect against pneumococcal disease, such as pneumonia, meningitis, and bloodstream infections.
  • You can get either Pneumococcal conjugate vaccine or Pneumococcal polysaccharide vaccine (but not both) when you get a flu vaccine.
  • Talk to your health care provider to find out which pneumococcal vaccines are recommended for you.

Other Preventive Actions for People with Living with HIV

In addition to getting a flu shot every year, people living with HIV should take the same everyday preventive actions CDC recommends of everyone, including avoiding people who are sick, covering coughs, and washing hands often.

In the context of the COVID-19 pandemic, local governments or public health departments may recommend additional precautions be taken in your community. Follow those instructions.

Flu Symptoms and Treatment

If you get sick with flu symptoms call your doctor right away. There are antiviral drugs that can treat flu illness and may prevent serious flu complications. These drugs work best the sooner they are started. CDC recommends prompt treatment for people who have flu infection or suspected flu infection and who are at higher risk of serious flu complications, such as people living with HIV.

Symptoms

Flu symptoms include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, and fatigue. Some people also may have vomiting and diarrhea, though this is more common in children than in adults People may be infected with flu and have respiratory symptoms without a fever.

Treatment

  • Influenza antiviral drugs are medicines that fight against flu by keeping flu viruses from making more viruses in your body.
  • Antiviral drugs can make your flu illness milder and make you feel better faster. They may also prevent serious health problems that can result from flu illness.
  • Treatment with an influenza antiviral drug should begin as soon as possible because these medications work best when started early (within 48 hours after symptoms start).
  • You need a prescription from a health care provider for an influenza antiviral medication.
  • There are four FDA-approved flu antiviral drugs recommended by CDC this season that can be used to treat the flu.
Emergency Warning Signs of Flu Complications

People experiencing these warning signs should obtain medical care right away.

In children
  • Fast breathing or trouble breathing
  • Bluish lips or face
  • Ribs pulling in with each breath
  • Chest pain
  • Severe muscle pain (child refuses to walk)
  • Dehydration (no urine for 8 hours, dry mouth, no tears when crying)
  • Not alert or interacting when awake
  • Seizures
  • Fever above 104°F
  • In children younger than 12 weeks, any fever
  • Fever or cough that improve but then return or worsen
  • Worsening of chronic medical conditions
In adults
  • Difficulty breathing or shortness of breath
  • Persistent pain or pressure in the chest or abdomen
  • Persistent dizziness, confusion, inability to arouse
  • Seizures
  • Not urinating
  • Severe muscle pain
  • Severe weakness or unsteadiness
  • Fever or cough that improve but then return or worsen
  • Worsening of chronic medical conditions

These lists are not all inclusive. Please consult your medical provider for any other symptom that is severe or concerning. 

Special Consideration Regarding Egg Allergy

People with egg allergies can receive any licensed, recommended age-appropriate influenza (flu) vaccine (IIV4, RIV4, ccIIV4, or LAIV4) that is otherwise appropriate. People who have a history of severe egg allergy (those who have had any symptom other than hives after exposure to egg) should be vaccinated in a medical setting, supervised by a health care provider who is able to recognize and manage severe allergic reactions. Two completely egg-free flu vaccine options are available: Flublok Quadrivalent recombinant flu vaccine and Flucelvax Quadrivalent cell-based flu shot.


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