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Flu Vaccination Indicated for HIV-Infected People

Although prevention of influenza in HIV-infected people is desirable, the efficacy of vaccination is unknown, and vaccination may carry a risk for increased HIV viral replication. To assess efficacy and safety, researchers in San Diego randomized 102 patients with HIV infection to receive influenza vaccine or a placebo injection. Most subjects had symptomatic HIV and CD4 counts of 500 or fewer cells/mm³.

One month after vaccination, more vaccine recipients than placebo recipients had developed protective antibody titers to two influenza antigens (23 percent vs. 9 percent for A/Johannesburg and 63 percent vs. 37 percent for B/Harbin). Placebo recipients actually were more likely to have protective titers against A/Texas antigen (30 percent vs. 10 percent). Nonetheless, no vaccine recipients with respiratory symptoms had serologic or viral culture evidence of influenza infection, whereas 10 placebo recipients did have such evidence -- a significant difference. There were no significant differences in plasma HIV-1 RNA.

Comment: Influenza vaccine appears to be efficacious in HIV-infected patients. A caveat in applying the results of this study is that few of the subjects had CD4 cell counts of 200 or fewer cells/mm³. But given the risk for influenza, the lack of adverse effects of vaccination, and vaccine efficacy, routine immunization of HIV-infected individuals is warranted.

— R Saitz

Published in Journal Watch General Medicine September 28, 1999

Citation(s):

Tasker SA et al. Efficacy of influenza vaccination in HIV-infected persons. A randomized, double-blind, placebo controlled trial. Ann Intern Med 1999 Sep 21 131 430-433.

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