Flu season rears its sneezing, achy, feverish and just plain ugly head each fall, and HIVers consider rolling up their sleeves and fighting back with a vaccination. Tejal Gandhi, MD, of the University of Michigan’s HIV/AIDS Treatment Program, says only a few people experience side effects from the shot, including “pain around the site, fatigue and muscle aches,” for a day or two. “The consequences of having influenza could be much more severe than any transient side effects,” Gandhi concludes. New York City HIVer and treatment pro Tim Horn attests: “I’ve had the flu twice in my life—the two years that I didn’t get the flu shot—and I was sick as a dog. Flu sucks.” That’s why Ghandi, like most HIV docs, recommends the flu vaccination “regardless of CD4 count.”

New York City’s Ricky Hsu, MD, cites an exception: He’s all for the shots unless HIVers have “fewer than 50 CD4 cells and uncontrolled viral loads.” Then, he says, your “chance of mounting a strong immune reaction to the vaccine is lower,” while the shot’s tendency to raise your viral load temporarily can tax a weakened immune system.

The standard shot can’t give you the flu, but HIVers should thumb their noses at the nasal-spray vaccine, which (unlike its injectable cousin) uses live virus. Avoid vaccination if you have egg allergies or previous sensitivity to the shot. And if you’re feverish from some illness or infection before the shot, postpone—and chill.