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HIV/AIDS and the Flu

Questions & Answers

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 estimated that about 1.2 million people in the United States were living with HIV at the end of 2013, the most recent year for which this information is available. People with HIV and AIDS 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, HIV-infected persons are recommended for vaccination. To help you prepare for the flu this season, this fact sheet provides Questions & Answers to guide the administration of both flu shots and antiviral medications to people with HIV and AIDS.

Should people with HIV/AIDS receive the inactivated influenza vaccine?

People with HIV and AIDS are at high risk of serious influenza-related complications and should get the inactivated influenza vaccine (the 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.

Are there people with HIV/AIDS who should NOT receive the inactivated influenza vaccine?

Contraindications to the use of inactivated influenza vaccine (the flu shot) in persons with HIV/AIDS are the same as those for persons without HIV/AIDS.

  • Children younger than 6 months of age (influenza vaccine is not approved for this age group)
  • Persons with any severe, life-threatening allergies. If a person has ever had a life-threatening allergic reaction after a dose of flu vaccine, or has a severe allergy to any part of this vaccine, including (for example) an allergy to gelatin, antibiotics, or eggs, they may be advised not to get vaccinated. Most, but not all, types of flu vaccine contain a small amount of egg protein. For people with milder egg allergies, see Influenza Vaccination of Persons with a History of Egg Allergy.
  • If a person ever had Guillain-Barré Syndrome (a severe paralyzing illness, also called GBS). Some people with a history of GBS should not get this vaccine. This should be discussed between the health care professional and patient.
  • If a person is not feeling well. It is usually okay to get flu vaccine when a mild illness is present, but the person might be advised to wait until they feel better.

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Should people with HIV/AIDS receive the nasal-spray flu vaccine (Live Attenuated Influenza Vaccine [LAIV] (FluMist®))?

No. While the nasal spray vaccine [LAIV] (FluMist®) is not recommended for use at all during 2016-2017, that 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).

Should people with HIV/AIDS receive influenza antiviral medications for treatment of influenza?

Yes. It’s very important that influenza antiviral drugs be used early to treat flu in people who are very sick with flu (for example people who are in the hospital) and people who are sick with flu and who have a greater chance of getting serious flu complications, such as people with HIV and AIDS.

Studies have shown that flu antiviral drugs work best for treatment if they are started within two days of getting sick. There may still be benefit in treating people with antiviral drugs even after two days have gone by, especially if the sick person has a greater chance of serious flu complications (See box) or is very sick, for example in the hospital because of the flu.

When should people with HIV/AIDS receive antiviral medications for chemoprophylaxis (prevention of influenza)?

People with HIV and AIDS 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 for 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 in the management of HIV-infected persons. Patients should be observed for adverse drug reactions to influenza antiviral chemoprophylaxis agents, especially when neurologic conditions or renal insufficiency is present.

Should health care workers who have contact with HIV/AIDS patients be vaccinated?

Influenza vaccination is recommended for health care workers, including those who are involved in direct care of HIV-infected patients. More information about vaccination of health care workers can be found in Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010.

Special Consideration Regarding Egg Allergy

The recommendations for vaccination of people with egg allergies have not changed since last season (2016-2017).

People with egg allergies can receive any licensed, recommended age-appropriate influenza vaccine and no longer have to be monitored for 30 minutes after receiving the vaccine. People who have severe egg allergies should be vaccinated in a medical setting and be supervised by a health care provider who is able to recognize and manage severe allergic conditions.

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