Rx for Winter Health

Even if you're not yet ready to let go of thoughts of summertime fun and the holidays ahead, we're already in the midst of the months when it's important to think about staying healthy this winter. If you haven't gotten one already, at the top of your list should be a yearly influenza vaccination. 'Although people with HIV have the same risk of catching the flu as anyone else, they are much more likely to feel ill from it or develop such complications as pneumonia, sinus infections, or the need for hospitalizations,' says Barry Zingman, medical director of the Montefiore AIDS Center in Bronx, N.Y. 'The mortality rate for people with the flu and HIV is also much higher. That's why all HIV-positive adults are urged to get a flu shot every year.' But there is a caveat. HIVers should opt for the flu shot, not the vaccine administered by nasal spray, warns Peter Shalit, an HIV specialist in Seattle. The nasal vaccine is made from live virus, which poses a slight risk of infection for people with low CD4-cell counts, he points out. The shot, on the other hand, is crafted from killed virus, so it is safer for HIVers. The shot is also quite effective, Zingman adds. Although the vaccine targets only three of the most prevalent flu viruses circulating in the winter and does not guarantee against contracting the illnesses, he says, studies have shown that the chances of severe complications of the flu are reduced by about 80% in people with HIV when they're vaccinated. That protection isn't permanent, however, lasting six months at best. Because of that, physicians warn against taking the shot too early and possibly losing protection before flu season ends in April or May. 'The optimum time to take it is in early November,' Shalit recommends. 'That will give your body enough time to respond to the vaccine--usually about two weeks--and you'll be ready just as the season begins.' Another key vaccine all HIVers should receive when diagnosed with HIV infection--regardless of the time of year--is the polysaccharide pneumococcal pneumonia vaccine, says Judith Feinberg, a professor of medicine at the University of Cincinnati and a former AIDS researcher at the National Institutes of Health. 'Invasive pneumococcal disease is definitely more frequent and more severe in people with HIV,' she says of the need to be vaccinated. The shot protects against the most common and deadly strains of pneumonia that are prevalent in the winter. The pneumonia vaccine should be given immediately upon HIV diagnosis, Feinberg says, and followed up with a booster every five to six years thereafter. She also revaccinates HIVers who received the shot while they had CD4-cell counts below 200, because some studies have shown that immune responses to the vaccine are not as robust in recipients with low CD4 counts. During the winter months HIVers with low CD4-cell counts also need to closely adhere to medications aimed at preventing Pneumocystis pneumonia, one of the most common AIDS-related opportunistic infections in HIV-positive adults. Although this form of pneumonia can strike at any time, it is diagnosed more frequently during the winter. 'I stress to my patients that they really need to stick to their regimens,' Zingman says, 'and to definitely not go on any drug holidays.' If you do come down with a winter ailment, Shalit says, it's important to be able to distinguish between a common cold, which doesn't need medical attention; the flu; or signs of a more serious illness like pneumonia. 'The biggest clue is if you have a fever,' he explains of the differences. 'If you have respiratory problems but no fever, chances are it's just a cold. Another key with a fever is that with the flu, you usually get a fever right away and it goes away within 48 hours or so. But if you're already feeling sick and a fever comes on later, or if you develop a fever that doesn't go away after a couple of days, you should go see your doctor.' You also can see your doctor to obtain antiviral medications that can shorten the duration of flu symptoms, Zingman adds. But the key is to get to your physician quickly, since prescription medications--Tamiflu pills and Relenza nasal spray--are effective only if started within 48 hours of the onset of flu symptoms. 'If you don't start them by then,' Zingman says, 'the meds won't make a difference later.' Over-the-counter flu and cold medications like antihistamines, cough syrups, and pain relievers are also perfectly safe for most HIVers, Shalit says. The only concern might be for patients taking other medications, like those to control high blood pressure, which can interact badly with some over-the-counter products. While there are plenty of available treatments to ease cold and flu symptoms, the best approach is to take steps to avoid catching the illnesses in the first place, urges Feinberg. That includes your mom's time-honored advice to frequently wash your hands, especially when at work or school, where community items can be handled by people who are ill; to avoid touching your mouth, eyes, and nose, which are portals for bacteria and viruses to enter your body; and to avoid close contact with anyone who is ill. Stopping smoking also can help lower one's chances of contracting a respiratory illness, Feinberg says. 'Smoking irritates your lung tissue,' she explains, 'and makes you more susceptible to respiratory infections like bronchitis or pneumonia.' One common wives' tale that holds some truth for HIVers is that exposure to cold drafts or frigid temperatures should be minimized, Zingman says. While it's completely untrue that these conditions boost a person's chances of contracting a cold or the flu, they can worsen HIV-related neuropathy. 'Symptoms tend to be much worse in the winter because of the cold,' he says. 'I advise my patients to wear mittens and socks, particularly wool mittens and socks.'