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People with HIV & Influenza (Flu)

People with HIV are at high risk of serious influenza-related complications. Studies done before routine use of highly active antiretroviral therapy (HAART) suggested an increased risk for heart- and lung-related hospitalizations in people infected with HIV during influenza season as opposed to other times of the year, and a higher risk of influenza-related death in HIV-infected people. Other studies have indicated that influenza symptoms might be prolonged and the risk of influenza-related complications is higher for certain HIV-infected people. Vaccination with a flu shot has been shown to produce an immune response against influenza viruses in certain people infected with HIV.

Because influenza can result in serious illness, an influenza vaccination is recommended for people with HIV.  This page covers recommendations on both flu shots and antiviral medications to people with HIV to help people with HIV prepare for the flu season.

What is HIV

HIV (human immunodeficiency virus) is the virus that can lead to AIDS (acquired immunodeficiency syndrome). HIV attacks cells in the body’s immune system and, if untreated, gradually destroys the body’s ability to fight infection and certain cancers. CDC estimates that about 1.1 million people in the United States were living with HIV at the end of 2015, the most recent year for which this information is available.

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

If you have HIV, you are at high risk of serious influenza-related complications and should get an injectable influenza vaccine (a flu shot). Persons with advanced HIV disease may have a poor immune response to vaccination. Therefore, pre-exposure chemoprophylaxis (use of antiviral medications to prevent influenza infection) may be considered for these patients if they are likely to be exposed to people with influenza.

  • Several randomized studies in HIV-infected adults have shown that flu vaccination can prevent influenza illness. Studies in the United States have shown that flu vaccination prevents illness and doctor’s visits among people with HIV and other conditions resulting in immune suppression.
  • Persons with advanced HIV disease may not respond as well to influenza vaccination as HIV-uninfected persons, but HIV-infected persons may still mount an immune response.

The reasons a person should not receive a flu vaccine are the same for people with HIV and those without HIV. More information on who should and who should NOT get a flu vaccine can be found here.

Flu Shots for People with HIV/AIDS

  • Injectable influenza vaccines (or flu shots) are approved for use in people with HIV and other health conditions.
  • Live Attenuated Influenza Vaccine [LAIV] (nasal spray) vaccine should NEVER 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).

Other Preventive Actions for People with HIV/AIDS

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

Antiviral medications for chemoprophylaxis (prevention of influenza) for People with HIV

People with HIV should be prescribed oral oseltamivir or inhaled zanamivir to prevent infection with influenza when they cannot otherwise be protected during times when there is a high risk of exposure to influenza. Use should be in accordance with current recommendations from CDC or local public health authorities. Current CDC guidance on use of chemoprophylaxis should be consulted, and updated recommendations from CDC can be found on the seasonal influenza (flu) site.

There are no published data on interactions between the recommended influenza antiviral agents (oseltamivir, zanamivir and peramivir) and drugs used by people to manage their HIV. Patients should be observed for adverse drug reactions to influenza antiviral chemoprophylaxis agents, especially when neurologic conditions or renal insufficiency is present.

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 prevent serious flu complications. CDC recommends prompt treatment for people who have influenza infection or suspected influenza infection and who are at high risk of serious flu complications, such as people with HIV.

Symptoms

Flu symptoms include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Some people may also have vomiting and diarrhea. People may be infected with the flu and have respiratory symptoms without a fever.

Treatment

  • Treatment should begin as soon as possible because antiviral drug treatment works best when started early (within 48 hours after symptoms start).
  • For you to get an antiviral drug, a doctor needs to write a prescription. These medicines 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.
  • There are three FDA-approved influenza antiviral drugs recommended by CDC this season that can be used to treat flu.
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When to Seek Emergency Medical Care

If you or your child have HIV/AIDS and experience any of the following emergency warning signs of flu sickness, seek medical attention right away!

Emergency Warning Signs of Flu Sickness

In children

  • Fast breathing or trouble breathing
  • Bluish skin color
  • Not drinking enough fluids
  • Not waking up or not interacting
  • Being so irritable that the child does not want to be held
  • Flu-like symptoms improve but then return with fever and worse cough
  • Fever with a rash

In adults

  • Difficulty breathing or shortness of breath
  • Pain or pressure in the chest or abdomen
  • Sudden dizziness
  • Confusion
  • Severe or persistent vomiting
  • Flu-like symptoms that improve but then return with fever and worse cough
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