About AIDS

President Bush, ignoring the lessons of the Swine Flu fiasco of 1976, has called for a massive resource build-up to combat a possible – but wildly over-hyped – epidemic of avian flu. He proposes to stockpile Tamiflu and Relenza to treat millions of bird flu cases, should any occur, and to ramp up vaccine production and distribution.

An avian flu epidemic anytime soon seems remote, as the few dangerous H5N1 cases have occurred principally among Southeast Asian poultry farmers, not in the US. The H5N1 strain does not seem casually transmitted between humans.

If avian flu arrives in the US, will HIV-positive people with damaged immune systems be at elevated risk?

Probably no more so than with other influenzas, observes distinguished AIDS researcher Joel Gallant, MD, MPH, of Johns Hopkins School of Medicine. "The flu is pretty much the flu if you have HIV."

So what is a poz person to do? Get vaccinated, if it is available, and take Tamiflu if flu strikes, Dr. Gallant says. No vaccine will prevent every type of influenza infection, and Tamiflu is not a cure. However, this precaution may shorten and reduce the severity of a case. (If an HIVer's CD4 count is under 100, vaccination may not be very effective.)

Frequently, a dangerous complication of any flu is pneumonia. At our October Dinner With the Doctor, noted HIV doc Bob Wallace, MD, also recommended annual flu vaccination, plus vaccination (Pneumovax 23) against Streptococcus pneumoniae. This bacteria family causes most pneumonias, and especially among AIDS patients, a blood infection called bacteremia (sepsis). Both are serious, with 15-35% fatality. Pneumovax is a one-time deal, perhaps with a booster in 5-10 years.

So, bottom line: Get your flu vaccination every year, and be sure you've had Pneumovax, too. That won't give you the flu, and it might help significantly. Even if Bush's bird flu gambit is primarily a profit generator for his Big Pharma friends and a political dog-and-pony diversion, the brouhaha reminds us that the ounce (0.5 milliliters, actually) of flu prevention is cheap and easy; the protection – priceless.