UK Community Advisory Board (UK-CAB)

Flu vaccination: What People living with HIV need to know

Key Points for People living with HIV

  • Flu is highly infectious and causes the death of many thousands of people every year in the UK, even with the flu vaccination programme
  • This year there is concern that we may see more flu infections than normal. There is also the added risk of getting COVID-19 and flu at the same time
  • People living with HIV are more at risk of serious illness, hospitalisation and death from flu than the general population
  • Everyone living with HIV should get a free flu vaccination via their GP
  • People living with HIV should avoid live flu vaccines
  • Close contacts of people living with HIV should also be offered a flu vaccine
  • The flu vaccine programme started in September. Ask your GP for the flu vaccine if you are not offered one by late October. If you still have problems, talk with your HIV healthcare team, they should be able to help you.

Flu in the UK

Every year, flu kills thousands of people in the UK. The precise number of deaths connected to flu is difficult to understand, this is because flu is often associated with other illnesses such as pneumonia. On average, it is estimated that flu causes 10,000 deaths a year in the UK, and in years where flu is especially bad, it can lead to as many as 20,000 deaths.

Sadly, these deaths happen even with the annual flu vaccination campaigns. The numbers would be even higher if people were not encouraged to be vaccinated against flu.

Who is most at risk?

The people most at risk of serious illness and death due to flu are:

  • Older adults
  • Very young children
  • Pregnant women
  • People with other underlying health conditions (this includes people living with HIV)
  • People with suppressed immune systems (such as those on chemotherapy for cancers)
  • Healthcare workers

It is difficult to predict what any given flu season (which in the UK falls during the winter months) is going to be like. There are strong fears that during winter 2021/22 the flu season will be significantly worse than ‘normal’. Last winter restrictions that were introduced to reduce the impact of the COVID-19 pandemic also affected flu, and we saw very few cases of flu. This year, without the same restrictions it is expected that cases will bounce back to higher than normal levels.

Currently the UK is still seeing high rates of COVID-19 infection, and it is not known what the impact of having both COVID-19 and flu might be.

Therefore, it is important to be vaccinated for both COVID-19 and flu.

The NHS flu vaccination programme started in September 2021. This year, everyone over the age of 50 will be invited to have a flu vaccine, as well as the other categories that are normally invited, which includes people living with HIV.

What is the advice for People living with HIV?
People living with HIV are more likely to get seriously ill with flu infections, with a greater risk of complications, hospitalisation and death. Being on effective antiretroviral therapy (ART), reduces the risk of hospitalisation and death, but the risk remains higher than for the general population.

All adults living with HIV should get an annual flu vaccination, no matter what your age. This includes pregnant women with HIV. You can get this free on the NHS.

Studies have shown that not everyone living with HIV is offered a flu vaccine. One study in 2015 found that fewer than 6 in 10 people living with HIV had been offered a flu vaccination, and not all of those offered a vaccination went on to get one.

People living with HIV should be offered a flu vaccine during September or early October, and you should contact your GP if you have not heard anything by late October. If your GP refuses to make you an appointment, or you do not have a GP, then talk with your HIV healthcare team at your clinic or hospital; they should be able to help you get a flu vaccine.

What flu vaccine should people living with HIV have?
There are different types of flu vaccine. The majority of people under 18 will get a live vaccine, delivered by a nasal spray. It is not recommended that people living with HIV receive a live vaccine.

This is especially the case if your immune system is weak (with a low CD4 count – below 200 cells/mm3). The evidence against using a live vaccine if your viral load is undetectable and your CD4 count is normal is less clear, but it is still better to avoid a live flu vaccine.

Most adults receive a flu vaccine that is not live but ‘inactivated’.
These use a version of the virus that has been killed. For flu, this will typically be a ‘quadrivalent vaccine’, which means it contains four of the most commonly circulating flu strains. For people who do not respond well to vaccines (such as those over 65, or those with weakened immune systems), a “boosted” version  of the quadrivalent vaccine (called ‘adjuvated’) is used, though if this is not available, then the other quadrivalent vaccines will be effective and should still be taken.

The efficacy rates of flu vaccines can vary, but this is not a reason to avoid getting the flu vaccine. Even with lower efficacy, there will be a level of protection.

Your close contacts, including family and friends living in the same household should be offered a flu vaccine.
If your immune system is very weak (CD4 lower than 200 cells/mm3), then these close contacts should also avoid the use of live flu vaccine.