2026-2027 Vaccine Guidance for HIV/AIDS: 6 Facts About Protection Against COVID, Flu, and RSV

Medically reviewed by Elizabeth Cueto, M.D.

Written by Ted Samson

Posted on November 4, 2026

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Key Takeaways

Updated recommendations for flu, COVID-19, and RSV vaccines for the 2026-27 respiratory season have been released by several leading medical organizations, with special guidance for people living with HIV.
Research reviewing hundreds of studies found that flu, COVID-19, and RSV vaccines continue to offer meaningful protection against severe illness and hospitalization, even for people with weakened immune systems. For people with HIV, factors like age, CD4 count, viral load, and HIV treatment can all play a role in which vaccines are recommended and when.
Talking with your HIV care team is an important step to figure out which vaccines make sense for you, whether you might need an additional COVID-19 dose, and which vaccine types to avoid, such as the live nasal spray flu vaccine, which is not recommended for people with HIV.

View all takeaways

Several leading medical organizations have released updated recommendations for flu, COVID-19, and respiratory syncytial virus (RSV) vaccines for the 2026-27 respiratory season. The guidance is available through the Vaccine Integrity Project. It’s particularly important for people living with human immunodeficiency virus (HIV).

HIV affects the immune system, including CD4 cells that help the body fight infections. People with advanced or untreated HIV may have weaker immune defenses.

HIV treatment can help protect immune function. For people with HIV, immune status can affect infection risk and the response to vaccination.

🗳️ Have you spoken with your doctor about COVID-19, flu, or RSV vaccinations for 2026-2027?

Yes, and it was helpful

Yes, but it wasn’t helpful

No, but I plan to

No, and I don’t plan to

Vaccines train the immune system to recognize and fight specific viruses. This can help your body respond more quickly if you’re exposed.

There isn’t one vaccine plan that’s right for everyone with HIV. Your age, CD4 count, HIV treatment and viral load, vaccination history, and other health conditions can all influence which vaccines are recommended and when you should receive them.

The New Vaccine Guidance Comes From Leading Medical Groups

The Vaccine Integrity Project, working with the American Medical Association, reviewed the latest evidence on flu, COVID-19, and RSV immunizations for the 2026-27 respiratory season. The findings helped inform recommendations from several leading medical organizations, including:

American Academy of Family Physicians
American Academy of Pediatrics
American College of Obstetricians and Gynecologists
Infectious Diseases Society of America (IDSA)

The review included 299 studies published mostly between August 2025 and June 2026. It found that flu, COVID-19, and RSV immunizations continued to provide meaningful protection against hospitalization, severe illness, and death.

Flu, COVID-19, and RSV immunizations continue to provide meaningful protection against hospitalization, severe illness, and death.

The amount of protection can vary based on the virus, the vaccine or immunization, the season, and a person’s health. For people with HIV, vaccination decisions should take into account factors such as age, CD4 count, and HIV viral load.

There Are Several New and Updated Vaccine Options

For the 2026-27 respiratory season, COVID-19 and flu vaccines have updated formulations. There are also three RSV vaccines for adults. These vaccines differ in how they are made and which age groups or risk groups they are approved for.

COVID-19 Vaccines

The U.S. Food and Drug Administration (FDA) has approved four COVID-19 vaccine options. All four vaccines are given by injection.

Vaccine	Vaccine Type	FDA-Approved Age Groups
Moderna mNexspike	mRNA	People 65 and older; people ages 12 through 64 with at least one underlying condition that increases their risk of severe COVID-19
Moderna Spikevax	mRNA	People 65 and older; people ages 6 months through 64 with at least one underlying condition that increases their risk of severe COVID-19
Novavax Nuvaxovid	Protein-based with an adjuvant (an ingredient that helps strengthen the immune response)	People 65 and older; people ages 12 through 64 with at least one underlying condition that increases their risk of severe COVID-19
Pfizer Comirnaty	mRNA	People 65 and older; people ages 5 through 64 with at least one underlying condition that increases their risk of severe COVID-19

The National Institutes of Health (NIH) recommends a current-season COVID-19 vaccine for adults and adolescents with HIV, regardless of CD4 count or viral load. People with advanced or untreated HIV may receive an additional dose six months after their last dose.

Flu Vaccines

All U.S. flu vaccines for the 2026-27 season are trivalent. This means they are designed to protect against three influenza viruses.

Afluria, Fluarix, FluLaval, and Fluzone

Vaccine Type

Standard-dose, egg-based, inactivated

How It’s Given

Injection

FDA-Approved Age Groups

People 6 months and older

Fluad

Vaccine Type

Egg-based, inactivated, contains an adjuvant

How It’s Given

Injection

FDA-Approved Age Groups

People 65 and older

Flublok

Vaccine Type

Recombinant, made without eggs

How It’s Given

Injection

FDA-Approved Age Groups

People 9 and older

Flucelvax

Vaccine Type

Cell-culture-based, inactivated

How It’s Given

Injection

FDA-Approved Age Groups

People 6 months and older

FluMist

Vaccine Type

Egg-based, live attenuated

How It’s Given

Nasal spray

FDA-Approved Age Groups

People ages 2 through 49

Fluzone High-Dose

Vaccine Type

Egg-based, inactivated, higher antigen dose

How It’s Given

Injection

FDA-Approved Age Groups

People 65 and older

Moderna mFlusiva

Vaccine Type

mRNA

How It’s Given

Injection

FDA-Approved Age Groups

People 50 and older

Most people need one flu vaccine dose each season. Some children may need a second dose based on their age, vaccination history, or individual health circumstances. For people with HIV, the NIH recommends an age-appropriate inactivated or recombinant flu vaccine each year.

The live-attenuated nasal flu vaccine FluMist contains a weakened form of the flu virus to help the body build protection. According to NIH guidance, people with HIV shouldn’t receive this vaccine, regardless of CD4 count.

RSV Vaccines

There are three FDA-approved adult RSV vaccines.

Vaccine	Vaccine Type	FDA-Approved Adult Use
GSK Arexvy	Protein-based vaccine with an adjuvant	People 60 and older; people ages 18 through 59 at increased risk of RSV lower respiratory tract disease
Moderna mResvia	mRNA vaccine	People 60 and older; people ages 18 through 59 at increased risk of RSV lower respiratory tract disease
Pfizer Abrysvo	Protein-based vaccine without an adjuvant	People 60 and older; people ages 18 through 59 at increased risk of RSV lower respiratory tract disease; use during weeks 32 through 36 of pregnancy to help protect infants from RSV.

For adults, the CDC recommends a single dose of RSV vaccine for everyone age 75 and older and for adults ages 50 through 74 who are at increased risk of severe RSV illness.

For people with HIV, the NIH recommends RSV vaccination at age 75 and older. For those ages 50 through 74, vaccination is recommended when the CD4 count is below 200 cells per cubic millimeter or another health condition raises the risk of severe RSV. The RSV vaccine isn’t currently given every year.

Vaccine Benefits Typically Outweigh Risks

For people who are immunocompromised, the benefits of vaccination generally outweigh the risks. Current evidence shows that flu, COVID-19, and RSV immunizations can reduce hospitalization, severe illness, and death. People with weakened immune systems may not respond as strongly to vaccines, but vaccination can still provide protection.

Vaccines can cause side effects, but serious side effects are uncommon. Your healthcare team can explain what to expect and help you weigh the benefits and risks based on your:

Treatment plan
Immune function
Age
Previous reactions
Other health conditions

There Are Special Considerations for People With HIV

The right vaccine and timing can vary for people with HIV. A lower CD4 count or untreated HIV can reduce the immune response to some vaccines, according to NIH guidance.

Ask not only which products are available, but which type, dose, and timing make sense for you.

Your healthcare team may consider:

Your current HIV treatment and whether your HIV is well controlled

Your CD4 count and whether your response to vaccination may be reduced

Whether you have advanced or untreated HIV, which can affect COVID-19 vaccine doses and certain other vaccine decisions

Your age, other health conditions, and previous vaccination history

Which vaccines and doses you’ve already received, including whether an additional COVID-19 dose may be appropriate

Some live vaccines may not be appropriate for people with HIV. For example, the nasal spray flu vaccine is a live vaccine and shouldn’t be used by people with HIV, regardless of CD4 count, according to NIH guidance.

Timing and Immune Health

Timing may also matter. The NIH HIV immunization guidelines recommend the current-season COVID-19 vaccine regardless of CD4 count or viral load. For RSV vaccination in people ages 50 through 74 with a CD4 count below 200 cells per cubic millimeter, some clinicians may consider waiting until immune function improves because data in this group are limited.

Your HIV care team can recommend the best timing based on your CD4 count, viral load, and vaccination history. Don’t delay, skip, or change HIV treatment to get vaccinated unless your healthcare team recommends it.

A Weaker Vaccine Response Can Still Offer Protection

People with weakened immune systems may not develop as strong a response to vaccines as people with healthy immune systems. That doesn’t mean vaccination has no benefit.

The Vaccine Integrity Project found that respiratory-virus immunizations continued to reduce severe outcomes among people with immunocompromising conditions, although protection varied.

For Some People, Several Vaccines May Be Given at Once

In many cases, COVID-19, flu, and RSV vaccines can be given at the same visit.

Whether that makes sense for you may depend on your immune status, previous vaccinations, expected side effects, and other health needs. Ask your HIV care team whether getting more than one vaccine at the same appointment is appropriate.