The Positive Side

Winter 2008 

Nothing to Sneeze at

For many PHAs, an annual flu shot is part of the strategy to beat the bug each winter. Suzanne MacCarthy investigates how Canadian researchers are working to make the vaccine even more effective. With contributions from Jennifer Chung.

WHETHER IT’S YOUR MOTHER’S CHICKEN SOUP or a double dose of vitamin C, everyone has a “prescription” for keeping the flu at bay. When these tactics fail and the sniffles, chills and aches invade, most people treat the flu as an unwelcome and uncomfortable nuisance. But for people with weakened immune systems, influenza can be much more than a nasty bug.

According to Dr. Curtis Cooper, an infectious disease specialist at The Ottawa Hospital, influenza is responsible for an average of 20,000 hospitalizations and 4,000 deaths each year in Canada — primarily among the elderly, young children and people with compromised immune systems. He explains that for people with HIV/AIDS (PHAs), the flu can lead to complications like pneumonia and even death. It can also last longer and result in more heart- and lung-related hospitalizations.

With flu season upon us, Cooper’s medical advice is: “Prevention, prevention, prevention.”

José Sousa, who was diagnosed with HIV in 1985, says he takes “lots of vitamin C in order to prevent or shorten the duration of the flu.” As a waiter who works closely with the public, Sousa is aware that he may be exposed to all kinds of contagious illnesses, so he tries to take good care of himself. Sousa knows the flu shot is an important part of his health strategy, and this year he’ll be making extra efforts to get one.

Cooper agrees that vaccination is one of the best ways to prevent specific strains of the flu virus. PHAs are especially encouraged to get a flu shot every year. “If [your viral load] is undetectable, usually you won’t experience the more severe symptoms,” says Sousa, who also chairs the committee at the Canadian HIV Trials Network (CTN) that reviews HIV/AIDS clinical research from a community perspective. “But if you have a weakened immune system, chances are the flu is going to be worse no matter how old you are.”

The influenza vaccine is considered the standard of care to protect PHAs from the flu, and overall its benefits outweigh its costs. Side effects associated with the vaccination include local injection-site pain, swelling and redness. Some people may experience brief periods of fevers and aches. However, Cooper and his physician colleagues have observed over time that the vaccine does not always ward off the bug and that the number of cases of influenza among PHAs remains quite high in Canada.

Two shots at the flu

Aware that one flu shot a year isn’t foolproof, Cooper and a team of Canadian researchers are currently investigating an innovative approach to maximize the effectiveness of the influenza vaccine in PHAs. Their study examines whether receiving multiple doses of the vaccine results in improved protection from the flu.

This past fall, eligible HIV-positive volunteers from across the country enrolled in the study and were randomly assigned to receive varying doses of Fluviral vaccine to help researchers find the most effective treatment strategy. Study CTN 237 set out to recruit 285 people at clinics in British Columbia, Alberta, Ontario, Quebec and Nova Scotia.

“There are not that many studies that examine flu vaccination strategies and HIV-positive people,” says Sousa. “This study will help determine whether a double dose of the vaccine or booster shot will produce enough antibodies in the body to fight the flu.”

In addition to potentially benefiting PHAs, Cooper explains that findings from this study could also help other people with compromised immune systems. “We’re eager to see if results from this study might be applicable to other populations, including those on corticosteroids as well as people living with autoimmune disease, organ transplantation and cancer,” he says.

Until one single strategy exists to avoid the flu entirely, Cooper will continue to advise his patients to take precautions in addition to getting their shot. Frequent hand-washing with soap and warm water is a must, he says. If soap and water are not available, alcohol-based hand sanitizers or hand wipes containing 60 to 90 percent ethyl alcohol or isopropanol can be very effective. Washing or sanitizing is particularly important if you touch your hands to your eyes, nose or mouth.

Whether testing new strategies for vaccination or providing advice for his patients, Cooper remains concerned that PHAs take the necessary precautions to protect themselves from the perils of influenza. “The first step to avoiding the nasty flu bug is to get a free flu vaccination from your healthcare professional.”

To learn more about the flu vaccination study (CTN 237) visit or call 1.800.661.4664. For general info on the flu and annual flu vaccination clinics near you, visit the Public Health Agency of Canada or speak to your healthcare provider.

Suzanne MacCarthy is Communications and Information Coordinator at the CIHR Canadian HIV Trials Network in Vancouver. Her adventures in HIV have taken her from Swaziland to British Columbia, with a stop in beautiful Cape Breton, Nova Scotia along the way.

Illustration: Mark Stay/

Doctor’s orders

If you do get sidelined by the flu bug, Dr. Curtis Cooper shares some helpful tips to get you back in the game.

  • Stay home and get enough rest.
  • Drink plenty of fluids like water and fruit juices, and avoid alcoholic beverages. Fluids are important if you have a fever because a fever can lead to dehydration.
  • For a stuffy nose, breathing moist air from a hot shower can help. Chicken noodle soup also helps loosen mucus.
  • Hot tea with lemon and honey soothes a sore throat.
  • A cough drop or plain hard candy can provide some relief from coughing.
  • Contact your healthcare provider as needed.