In addition to several clinical tests, patients with HIV disease should receive booster shots or new vaccines for immunizations they are missing, says Tom Barrett, MD, a staff physician at Chicago's Howard Brown Health Center. Because HIV-positive people may be more prone to certain infections or experience more severe symptoms of others, 'one of the first things we do is make sure immunizations are up-to-date,' Barrett notes. Among these are:
' Hepatitis A and B. Given immediately.
' Tetanus. If the previous booster was given more than 10 years ago.
' Flu shots. Given each year in the fall. Although there is no hard data, some doctors worry that immunocompromised patients may be at a higher risk for severe complications from the flu, such as pneumonia. Flu vaccines are recommended for most HIVers.
' Pneumococcal vaccine to prevent bacterial pneumonia. Given each year in the fall. Daar says all HIV-positive people, not just those with low CD4-cell counts, are at a higher risk for this illness. Some studies suggest the risk is boosted by as much as 100 times.
' Chicken pox. Some doctors choose to vaccinate their patients with high CD4-cell counts against chicken pox because the disease can be much worse and more aggressive in HIV-positive people, says Barrett.
On the flip side, vaccines that should not be given to HIVers include those that use a weakened form of a virus to convey immunity to the disease, including measles, mumps, rubella, polio, and smallpox.
