AIDS TREATMENT NEWS Issue # 185, October 15, 1993
Dave Gilden
The U.S. Public Health Service is recommending that all persons at special risk for flu complications get the updated version of the flu vaccine by November 15. Among these "at risk" groups are people with HIV. A poster presentation (#2249) at Berlin's International Conference on AIDS found that flu vaccine coverage in the U.S. is "sub optimal," with only about a third of people with HIV receiving the vaccine. Also in Berlin, three posters described a low response rate to the vaccine, especially among people with greatly reduced helper T-cell counts (posters 500, 1264 and 1276).
Stephen Follansbee, M.D., a San Francisco AIDS specialist who is following the issue, nevertheless urges anyone with HIV to be vaccinated. Complications from infection with the influenza virus include bacterial pneumonia, which can be fatal. For people with low T-helper cell counts, Dr. Follansbee suggests that all housemates also have themselves vaccinated. This would create a kind of sanitary wall around the person most in danger.
However, those with a history of allergic reactions to flu shots or to eggs should not be inoculated; and those with fevers should wait until the fevers subside. The vaccine consists of killed influenza virus that was grown in egg cells.
Two posters (209, 1929) in Berlin also dealt with the question of whether flu vaccination increases the level of HIV in the body, due to the immune stimulation the inoculant provokes. Increased HIV replication might spark a further decline in the immune system.
One of the posters said the vaccine does increase viral load for several months; the other found no change. To look at the question further, Dr. Follansbee and a group of associates are planning a short, 30-person trial involving HIV-infected volunteers at different helper T-cell counts. HIV levels and immune function will be measured for 28 days after vaccination.
The trial is now completely enrolled, and a full analysis of the data will not be completed until December at the earliest, well after the recommended vaccination period is over. But Dr. Follansbee says, "I don't want the study to undermine people getting shots." Any negative effect of the flu vaccine is probably minor, compared to the damage the flu could cause.
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