Date: Wed, 6 Dec 1995 02:08:35 +0500
From: ghmcleaf{CONTRACTOR/ASPEN/ghmcleaf}%NAC-GATEWAY.ASPEN@ace.aspensys.com
Subject: CDC Natl AIDS Hotline Training Bull #161


           CENTERS FOR DISEASE CONTROL AND PREVENTION
                       HIV/AIDS PREVENTION
           CDC NATIONAL AIDS HOTLINE TRAINING BULLETIN
.................................................................
October 24, 1995                                            #161

This is the answer from the Centers for Disease Control and
Prevention (CDC) to a question from the CDC National AIDS Hotline
concerning whether HIV-infected persons should be vaccinated
against the flu.

CDC's recommendations regarding flu vaccine for HIV-infected
persons can be found in "Prevention and Control of Influenza:
Recommendations of the Advisory Committee on Immunization
Practices (ACIP)" as reported in MMWR, April 21, 1995, Vol. 44,
No. RR-3, pp. 5-6 and in "USPHS/IDSA Guidelines for the
Prevention of Opportunistic Infections in Persons Infected with
HIV: A Summary" as reported in MMWR, July 14, 1995, Vol. 44, No.
RR-8, pp 25 and 28.

CDC's basic recommendation is that HIV-infected adults,
adolescents, and children be vaccinated against influenza
annually.  CDC views this as a recommendation "for
consideration."  To quote the July 14 MMWR, "These immunizations
... should be considered for use in HIV-infected patients.  While
the use of those products is logical, their clinical efficacy has
not been validated in this population."  (p. 25)  What this means
is that HIV-infected callers should discuss the pros and cons of
the flu vaccine with their provider.

CDC also recommends that flu vaccine be included in the
immunization schedule of HIV-exposed/infected infants.  CDC makes
this recommendation much more strongly than it does that for
vaccinating adults, adolescents, and children.  CDC thinks
vaccination should be viewed as standard care for all
HIV-exposed/infected infants.

The decision to vaccinate is complicated by at least three
important unresolved issues:

1.   Are HIV+ people really at greater risk from influenza than
     HIV-negative people?

     There is some evidence for this, but actually the scientific
     jury is still out on this one.  We do know, however, that
     some bacterial infections that can develop as complications
     of influenza infection (which is viral) can be more severe
     in HIV-infected persons.

2.   Do people with HIV really derive benefit from the vaccine?

     In general, the lower the CD4 count, the less likely a
     person is to develop the desired antibody response to the
     vaccine, but no one knows what the threshold is below which
     it's pointless to administer the vaccine.

3.   Could the flu vaccine actually accelerate the course of HIV
     disease?

     This issue has been raised in the HIV press.  An article in
     the June/July 1995 "POZ" ponders whether introducing a
     vaccine or any other foreign substance into the body might
     stimulate HIV progression.  A recent publication in the
     journal "Blood" (1995, Vol. 86, pp. 1082-1089) reported
     increased HIV viral burden following flu vaccination.
     However, this increase appears to be temporary in most
     people, and we don't know that people get sicker faster
     because of it.

A physician will want to take these questions into account and
also consider where an individual is in the course of HIV disease
(as indicated by absolute CD4 count) in making a specific
recommendation to that patient about vaccination.

Because so many relevant issues remain unresolved, CDC concludes
that it is too early for any revision of its basic recommendation
that HIV-infected adults, adolescents, and children be vaccinated
annually against influenza.  That basic recommendation is the
primary message we should be giving our callers, coupled with the
very important statement that CDC also recommends each
HIV-infected person discuss this issue with his/her physician.

Disclaimer:  CDC Hotline Training Bulletins

The information in the "CDC Hotline Training Bulletins" is
provided by CDC and NIH for use by the CDC National AIDS Hotline
in responding to general questions from the public about HIV and
AIDS.  The bulletins are not intended to be comprehensive
discussions of the subject areas.  Treatment and drug therapy
options change as new research and clinical experiences broaden
scientific knowledge.  Therefore, persons seeking information on
drug therapy should refer to the product information sheet
included in all drug packages for the most current and accurate
information about a particular drug, especially if the drug is
new or infrequently used.  HIV-infected individuals should
consult their personal physician for specific concerns about
their health.  For persons desiring more information on a
specific topic, public, medical, and university libraries can
provide excellent references.  The AIDS Clinical Trials
Information Service (800-874-2572) can provide information about
ongoing HIV/AIDS clinical trials; the HIV/AIDS Treatment
Information Service (800-448-0440) can assist with information
about the latest treatments for persons with HIV infection or
AIDS.