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HIV and Flu Fears
Nov 13, 2009

Hey Doc,

If someone has HIV what are the risks and complications they can have if they get the seasonal flu or even the H1N1 flu?

Thanks.

Response from Dr. Frascino

Hello,

Excellent question! From what we know so far, HIVers in general do not appear to be more susceptible to or to have a significantly greater risk for complications from novel H1N1 ("swine") flu. However, "virally enhanced" folks with significant immune deficiency (CD4 counts less than 200) may be at greater risk. I encourage all "positively charged" folks to get both the seasonal flu and novel H1N1 ("swine flu") vaccines.

I'll post below the latest information about HIV and H1N1. Also, you can follow the latest CDC recommendations on its Web site at www.cdc.gov/h1n1flu.

Good luck. Be well.

Dr. Bob

H1N1 "SWINE" FLU (BETA, FALL 2009)

The ongoing worldwide epidemic of H1N1 influenza A commonly referred to as "swine flu," though it features a unique combination of elements of swine, bird, and human influenza virusesraises concerns for people with HIV and other underlying medical conditions.

The H1N1 flu, which was first identified in Mexico in March 2009, appears to cause relatively mild illness compared with typical seasonal flu. It is generally susceptible to the flu drug oseltamivir (Tamiflu), but resistant cases have been identified in various regions. H1N1 influenza initially appeared to cause severe illness in healthy young adults unlike most seasonal flu, which usually causes more complications in children and elderly people, but similar to the deadly 1918 pandemic flu. In the U.S., however, most cases of hospitalization or death due to H1N1 flu have involved pregnant women and people with chronic underlying illnesses.

To date, however, it does not appear that HIV positive people are at significantly greater risk for complications related to H1N1 influenza. Researchers with the French Institute of Public Health recently reported that an analysis of 564 H1N1 flu deaths reported through mid-July, of which 213 had detailed information available, revealed that obesity and diabetes were the conditions most often associated with death (57 cases). In addition, 37 fatal cases involved respiratory disease, 36 involved heart disease, and 19 involved unspecified infectious diseases. Although 16 people who died with H1N1 flu had suppressed immune functionin- cluding five with cancer, two transplant recipients, and three with autoimmune diseasesHIV was not identified as a risk factor.

While HIV positive individuals overall do not appear more susceptible to H1N1 infection or complications, people with advanced immune suppression (indicated by a CD4 count of 200 cells/mm3 or less) may be at greater risk. In April, the CDC issued interim guidance for flu manage- ment for clinicians treating people with HIV. The agency noted that no unusual adverse effects of flu drugs have been reported among HIV positive people, and there are no known contraindications for using these medications with antiretroviral therapy.

In August, the CDC's Advisory Committee on Immunization Practices issued a list of priority groups to receive the H1N1 vaccine, which includes children and pregnant women, but not people with HIV. Experts do not know how H1N1 influenza will evolve, how widespread the outbreak will be during the North American winter flu season, or how H1N1 might interact with normal seasonal flu variants. HIV positive people are advised to consult their clinicians and keep abreast of the latest public health recommendations, available online at www.cdc.gov/h1n1flu.



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