Stay well this winter

As winter approaches the activity of viruses that cause colds and flu start to increase as do bacterial infections that cause chest infections. Coronavirus cases remain relatively high and are likely to increase as we move into Autumn and the Winter Months.

The level of coronavirus infection in the population remains high this Autumn and seasonal flu infections are expected to be higher than last year due to population immunity to flu being reduced.

This year’s autumn seasonal flu and coronavirus vaccine programmes for those who may experience severe illness due to other health conditions, will start earlier than planned in England. Vaccinations will start on 11th September this year and will be administered by GP’s and Community Pharmacies.

Having the seasonal flu vaccination and coronavirus booster in the next few months is important for people living with HIV, particularly those who also have other underlying health conditions. Dual infection with flu and coronavirus significantly increases the risk of very serious illness, hospitalisation, and death.

Aside from physical illness during the Winter months it’s becoming increasingly important to look after our emotional wellbeing and mental health. As daylight hours become shorter some people experience a change in their mood and the body produces less natural vitamin D, requiring supplementation.

Coronavirus (COVID-19) vaccination

The coronavirus vaccination programme has been very successful at reducing levels of severe illness, hospitalisation, and death from COVID-19. Vaccination does not prevent the transmission of coronavirus and it is still possible to get coronavirus once vaccinated.

Who should have the coronavirus vaccination?
The British HIV Association (BHIVA) recommend people living with HIV should have primary vaccinations followed up with any boosters when they are recommended, 6-months after the last primary vaccination. This advice is echoed the UK Health Security Agency (UKHSA) in the Green Book (vaccination bible).

For people with a CD4 cell count below 200 or those who have experienced advanced HIV illness in the previous 12 months, a third ‘primary’ vaccination is recommended, prior to having the booster. It is expected that the booster to be given to this group 6 months after the third primary vaccination.

Where can I get the coronavirus vaccination?
If you have not had the primary coronavirus vaccinations, speak to your GP who can administer these at any time of the year. We strongly recommend everyone living with HIV has the full course of coronavirus vaccinations and boosters when they are contacted by the NHS.

Where can I get the coronavirus booster vaccination?
If your GP is aware you’re living with HIV and have other health conditions which may mean you’re more vulnerable to severe illness you will be invited to attend for vaccination by your local provider. Local providers will vary depending on your location in the UK as each of the regions (England, Scotland, Wales, and Northern Ireland) have slightly different arrangements in place.

If your GP isn’t aware you’re living with HIV it’s important to let them know so you can be offered the vaccinations at the right time which will ensure your immunity levels to coronavirus are maintained throughout the year.

Do I need to get the coronavirus booster vaccination this Autumn?
The short answer is yes. We strongly recommend you have the booster vaccination even if you had one in the earlier part of the year. Immunity provided by vaccination reduces over time and needs to be topped-up. There is also a new variant of coronavirus in circulation, and this makes it more important to have the booster when you’re invited.

Can I still get coronavirus despite having the vaccination?
The short answer is yes. The primary aim of the coronavirus vaccine is to prevent severe illness, hospitalisation, and death. If you’re unlucky enough to get coronavirus the severity of symptoms can be significantly reduced, and it is likely you will recover in a shorter time.

Can I have the seasonal flu and coronavirus vaccinations at the same time?
Yes, you can! The UKHSA are encouraging dual vaccination to make it more convenient and to save time on separate appointments. For most people having both vaccinations at the same time doesn’t cause any problems or increase the possibility of experiencing vaccination reactions. If you’ve had reactions in the past to either of the vaccinations talk to the service provider who will be able to provide further advice and support.

Seasonal flu vaccination

Influenza (flu) is a relatively mild illness for most people, but it can be serious resulting in hospitalisation and in very severe cases death. Its estimated there are 13,500 deaths a year due to seasonal flu. During the 2022/23 seasonal flu period there were 14,500 deaths. Having the seasonal flu vaccination is a good preventative step to ensure you stay well over the Winter months.

Who should have the flu vaccination?
The British HIV Association (BHIVA) recommend everyone living with HIV should have the seasonal flu vaccination each year regardless of being on treatment or CD4 cell count. Vaccines are never 100% effective, but vaccination can significantly reduce the severity of symptoms and duration of illness should you be unfortunate enough to get flu.

Where can I get the flu vaccination?
There are different arrangements in place across the UK when it comes to offering the flu vaccination. In some regions outside of England HIV clinics can give the seasonal flu vaccination. All GP’s, midwife services and many high street pharmacies provide the seasonal flu vaccination service. In England, if your GP practice isn’t aware that you are living with HIV you won’t be contacted and invited to get a free flu vaccination.

Highstreet pharmacies offer a free flu vaccination service for those who are eligible and a paid service for those who don’t fall under the free NHS vaccination programme. If you are uncomfortable sharing your HIV status to be eligible to receive the free vaccination, you can use the paid service which is approximately £17 this year.

Can I have the seasonal flu and coronavirus vaccinations at the same time?
Yes, you can! The UKHSA are encouraging dual vaccination to make it more convenient and to save time on separate appointments. For most people having both vaccinations at the same time doesn’t cause any problems or increase the possibility of experiencing vaccination reactions. If you’ve had reactions in the past to either of the vaccinations talk to the service provider who will be able to provide further advice and support.

Can I still get flu after having the vaccination?
It is possible to get flu after having the vaccination, particularly in the first few weeks after having it. This is because it can take up to 3 weeks for antibodies to form and protect you from flu. This year the seasonal flu vaccination program is being brought forward and will be available from Monday 11th September 2023.

Pneumonia vaccination

Pneumonia is caused by a bacterial infection of the lungs which become inflamed (one side or both) making it difficult to breath properly and for the body to get enough oxygen. Coronavirus can cause viral pneumonia, so it’s important to get your symptoms checked out to make sure there is a correct diagnosis, and the right treatment is given.

Who should have the pneumonia vaccination?
BHIVA vaccination guidelines and the UK Health Security Agency (UKHSA) Green Book, (vaccination bible) recommend people living with HIV receive the pneumonia vaccination. There is a difference in the type of vaccine recommended for adults people living with HIV when compared to the general adult population.

Which of the vaccines should I have?
The BHIVA guidelines recommend the use of a vaccine called PCV-13 (Prevnar-13), which provides a superior immune response, which may be particularly important for people with lower CD4 cell counts. The UKHSA Green Book recommends the use of the vaccine called PPV-23 (Pneumococcal Polysaccharide Vaccine) which is used for adults over the age of 65 or those who have other long-term health condition which makes them eligible regardless of their age.

The PPV-23 vaccination offers protection against 23 different strains of pneumococcus and is usually offered to people who are at particular risk of acquiring pneumonia due to their work environment as an example. The Prevnar-13 vaccination is recommended for everyone living with HIV regardless of their CD4 cell count or viral load or increased risk of acquiring pneumonia.

It is also possible to have both vaccinations but there needs to be a period of at least 3 months between having the different vaccinations. The evidence on the benefit of having both is limited and not recommended by BHIVA at this time.

Where can I get the pneumonia vaccination?
GP’s provide the pneumonia vaccination free of charge for those who are eligible. They are only able to offer the vaccination if they are aware you are living with HIV. Some high street pharmacies provide the pneumonia vaccination, but it costs around £70, which is expensive, but could be useful if you prefer not to share your HIV status with your GP.

Do I have to get the pneumonia vaccination every year?
The short answer is no. The antibodies produced by the vaccination can provide effective cover for up to 10 years, although for some people living with HIV and other health conditions may need a booster to be given after five years

Can I still get pneumonia despite having the vaccination?
You can still get pneumonia after having the vaccination, particularly in the first few weeks as it can take time for the body to produce antibodies. If you’re unfortunate enough to get pneumonia, it’s likely the severity of symptoms and length of illness may be reduced as the immune system will have been ‘primed’ to fight the infection.

Vitamin D supplements

Vitamin D is needed for the regulation of calcium and phosphate in the body, which in turn helps maintain bone, teeth, and muscle health. It is also important for the regulation or some hormones, and is associated with thyroid function, changes in oestrogen in women and testosterone in men.

During the Spring and Summer months most of the vitamin D the body requires is made by the effect of sunlight on the skin. Foods rich in vitamin D are also an important source, although it can be difficult to get enough vitamin D from diet alone.

Some studies have shown up to 85% of people living with HIV have low levels or a severe deficiency of vitamin D. It is thought HIV related inflammation may interfere with ability of the liver and kidneys to produce the active form of vitamin D known as calcitriol.

Vitamin D Supplementation is sometimes recommended for people living with HIV particularly where there are concerns about bone health, or other symptoms such as tiredness, low mood, depression and weight gain.

Vitamin D supplementation is more important between October and March as daylight hours are shortened and therefore less vitamin D is produced by the action of light on the skin. The UK Health Security Agency recommend adults take a daily supplement which includes 10 micrograms (400 international units) of vitamin D. If you are using a supplement that contains minerals (calcium, magnesium, zinc, iron, aluminium) it’s important to check for any interactions with your HIV medication and allow for a sufficient time separation between taking your HIV medication and any supplements.

Vitamin D isn’t usually included as part of the routine blood monitoring for people living with HIV. You can ask your clinic to run a test, but increasingly clinic teams are likely to refer you to your GP to get the test.

Where vitamin D levels are found to be low or deficient a high dose of around 20,000 international units can be prescribed for a period, with a lower maintenance dose equivalent to 20,000 international units over a month.

Seasonal affective disorder (SAD)

SAD is a seasonal disorder which can lead to the development of low mood, depression, lack of energy, tiredness, sleeping longer than usual and craving carbohydrate rich foods. SAD is common during the Autumn and Winter months when the daylight hours are shortened, and we spend more time indoors.

It’s not entirely clear what causes symptoms relating to SAD, and there is a possibly a genetic link as it seems to run in families. It’s thought that a lack of sunlight has an impact on a part of the brain called the hypothalamus which may affect the production of hormones such as melatonin (regulates sleep) and serotonin (helps regulate mood, appetite, and sleep). The regulation of our internal body clock (circadian rhythm) is dependent on sunlight and is responsible for the time we wake up which also regulates other body functions.

People living with HIV experience periods of low mood and depression and it’s possible the symptoms of SAD may add to these feelings. Many people feel down or experience the ‘Winter blues’ which can become debilitating, so it’s important to get in touch with your GP if you think you may find the Winter months’ particularly difficult.

Changes in lifestyle are one of the key areas to help ease the symptoms of SAD. Try to get as much natural sunlight as possible, exercising regularly and manage your stress levels. Light therapy can also be helpful although there is a need to purchase a specially designed SAD lamp which ensures the concentration of light provided is sufficient to simulate the hypothalamus. A lamp that emits 10,000 lumens (or more) is required to be effective.

Other approaches include talking therapies, particularly cognitive behavioural therapy (CBT). Antidepressant medicines can also be used to help ease low mood and depression ideally supported by some form of talking therapy or counselling.