Flu & People Living with HIV
Updated August 31, 2020
exclamation square light icon Getting a flu vaccine during 2020-2021 is more important than ever because of the ongoing COVID-19 pandemic. Flu vaccination is especially important for people with certain underlying medical conditions, like asthma, heart disease, and diabetes. People with these types of conditions are at higher risk of developing serious complications from flu. Many of these conditions also increase the risk for serious outcomes from COVID-19.
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 about 1.1 million people in the United States aged 13 years and older were living with HIV at the end of 2016, the most recent year for which this information is available.
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Find VaccinesPeople with HIV 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). Studies done before routine use of antiretroviral therapy (ART) suggested an increased risk for heart- and lung-related hospitalizations in people with HIVexternal icon during flu season as opposed to other times of the year. Other studies have indicated that flu symptoms might be prolonged and the risk of flu-related complications and prolonged flu virus sheddingexternal icon is higher for certain people living with HIV.
Because they are at high risk of serious flu-related complications it is especially important that people living with HIV get a flu shot annually. Flu vaccination works much better for people living with HIV who are receiving ART. Because flu vaccine effectiveness is not 100%, people living with HIV 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 people with HIV and the use of influenza antiviral drugs in people living with HIV.
A Flu Shot is the Best Protection Against Flu
If you have HIV, you are at high 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 people with HIV 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 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).
Note: While people with HIV 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.)
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 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 high risk of serious flu complications, such as people living with HIV.
Flu symptoms include cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue, often with fever. However, some people with the flu can have respiratory symptoms without a fever.
- Treatment should begin as soon as possible because antiviral drug treatment works best when started early (within 48 hours after symptoms start).
- Flu antiviral drugs are only available with 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 four FDA-approved influenza antiviral drugs recommended by CDC this season that can be used to treat flu.
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 less 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 vaccine (IIV, RIV4, 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 (ovalbumin-free) flu vaccine options are available: quadrivalent recombinant vaccine and quadrivalent cell-based vaccine.
