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What Does H1N1 (Swine) Flu Mean for People With HIV/AIDS?

HIV Expert Joel Gallant, M.D., M.P.H., Provides the Details

Last Updated: July 21, 2009

This podcast is a part of the series HIV News & Views. To subscribe to this series, click here.

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[Editor's Note: This interview was initially posted on April 29, 2009, when the virus formally known as novel influenza A (H1N1) was just beginning to spread worldwide. We will continue to periodically update this article as needed to ensure its accuracy, but as the months pass since it was first posted, we've found that Dr. Gallant's words still largely hold as true as they did in April, and that many of his predictions have indeed come true.]

As the H1N1 ("swine flu") virus has made its way across the world, so has misinformation and confusion about what the virus is and what sort of threat it poses. This holds particularly true for people with weakened immune systems or some people living with HIV. To help us fill in that knowledge gap, we've asked Dr. Joel Gallant for some insights. Dr. Gallant is a professor of medicine and epidemiology in the Division of Infectious Diseases at the Johns Hopkins University School of Medicine and he happens to be one of the leading HIV specialists in the United States.

Dr. Gallant, thank you very much for talking with us.

Joel E. Gallant, M.D., M.P.H.

Joel E. Gallant,
M.D., M.P.H.

Thank you, Myles. My pleasure.

Let's start with the basics. What is swine flu?

Swine flu is just a new strain of flu that has not been circulating in the population. As a result, nobody has any immunity to it. It's an influenza virus, just like other influenza viruses, but it's just one that human beings haven't seen before and as a result, our immune systems don't have any memory of it and that makes us a little more vulnerable.

When it comes to people living with HIV then, how does this translate? Are people with HIV more at risk for coming down with swine flu?

Not really. HIV-infected people are not in general at greater risk of influenza or flu than other people. And that's in part because the cellular immune system, the part of the immune system that the CD4 cells comprise, is not really responsible for fighting the flu. As a result, HIV doesn't make you more susceptible. For most people with HIV, the swine flu is pretty much the same as it would be with somebody without HIV.

"For most people with HIV, the swine flu is pretty much the same as it would be with somebody without HIV."

The only exception to that is that because people with HIV are at higher risk for pneumonia and because flu can increase your risk of pneumonia as a complication of flu, people with low CD4 cells could be at higher risk of complications of flu if they do get the flu and that the most important complication is pneumonia.

So the bottom line is that if you're HIV positive, but you're on HIV medications and doing well and have a reasonably good CD4, then there's probably not much to worry about. But if you're quite immunosuppressed -- if your CD4 is well below 200 -- then there is a slightly increased risk, but certainly not the same level as the risk of some other diseases like tuberculosis or something like that where the CD4 cells are so important.

It sounds like people with HIV have a greater risk not of getting swine flu necessarily, but of suffering complications related to it if they have a low CD4 count.

That's right, yes. The risk of getting the flu is the same.

I'm assuming viral load doesn't make a difference here.

Probably not much. Again, the viral load could contribute a little bit to the risk of complicated flu, if you had a high viral load. Although, I suspect the CD4 count would be a little more important.

What Can I Do to Protect Myself From Getting Sick From Swine Flu?

There are everyday actions that can help prevent the spread of germs that cause respiratory illnesses like influenza. Take these everyday steps to protect your health:

  • Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
  • Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
  • Avoid touching your eyes, nose or mouth. Germs spread this way.
  • Try to avoid close contact with sick people.
  • If you get sick with influenza, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

From the U.S. Centers for Disease Control and Prevention

For more information on swine flu, visit TheBody.com's collection of articles on swine flu.

Certainly at our clinic [Moore Clinic in Maryland -- click here for contact information] we try to vaccinate everybody against the flu, but in general, if you look at most influenza seasons, we really don't see a lot of people getting really sick from the flu. We don't really see a lot of need for hospitalization. And certainly, we don't see a lot of deaths.

So I think that with respect to the swine flu, it shouldn't be much different given what we know so far about this strain now. Although, again, this is a new epidemic and we may get more information as time moves along.

Are there any precautions HIV-positive people need to take to protect themselves from swine flu?

It's pretty much the same as for anyone else. Normally I would say get a vaccination, but that's not available yet for this strain of flu, so the next best thing you can do is:

  • Try to stay away from people who are sick.
  • Wash your hands -- because hand contact is a very common way of spreading this.
  • If there's flu going on in your community and you can avoid being in crowded places with a lot of people, that probably would help.

But short of that, there's not really much you could do.

You said there's no vaccination for this flu. But what if someone got vaccinated for the flu before the winter -- will that do anything to protect them from swine flu?

No, unfortunately it won't. The vaccine for this last winter's flu covered flu strains that are not the same as this swine flu and it would not provide protection.

Alright, so that flu bird has flown?

Yes, exactly. They are trying to come up with a vaccine for this one, but that wouldn't be available for some time.

If a person were to come down with swine flu, what are the treatments that are typically available?

There are actually a number of drugs that are active against various strains of flu. The ones that are most widely used are Tamiflu [oseltamivir], which is a pill, and then Relenza [zanamivir], which is an inhalation. Both of them are effective against this strain of flu, so if you were to come down with symptoms, then it would be important to try to get this medication and start taking it relatively soon. You don't want to wait too long or it ceases to be effective.

Remember that a lot of people will refer to cold symptoms as a flu, but it's important to distinguish between a common cold and a flu. Flu is something where you have pretty significant fever and muscle aches and fatigue before you actually get respiratory symptoms. So it's not like a cold where you get a sore throat and then maybe you feel sick a day or two later. With swine flu you really can all of a sudden feel really wiped out with muscle aches and fever and that would be a time when you'd want to start taking medication.

"It's important to distinguish between a common cold and a flu. Flu is something where you have pretty significant fever and muscle aches and fatigue before you actually get respiratory symptoms. So it's not like a cold where you get a sore throat and then maybe you feel sick a day or two later."

Do you know how readily available Tamiflu or Relenza are?

I have not heard of any shortages at the present time. I'm told that there are big stockpiles and that there is enough Tamiflu to go around, that it's being shipped out to states that are reporting flu cases, so I haven't heard. There's certainly no reason to rush out and try to stockpile it. It is available.

Is this the sort of thing that is typically covered by private health insurance, Medicare, ADAPs [AIDS Drug Assistance Programs]?

It's covered by private health insurance. I'm not aware of whether it's on ADAP formularies. I sort of doubt it, although perhaps some states would have it. That's a state-by-state issue.

Can Tamiflu or Relenza potentially interact with HIV medications or with the medications used to treat infections, such as pneumonia?

No, the drug can be used with antiretrovirals. There are no significant drug interactions. It can be used with the drugs we commonly use to treat or prevent pneumonia. So that really should not be a concern, but do keep in mind that if you were to develop flu and then develop pneumonia -- of course by then, I hope you would be under the care of a doctor -- that Bactrim [co-trimoxazole] may not be the right drug. So Bactrim's a good drug for pneumocystis, but not a great drug for the types of pneumonia that might complicate flu.

Alright, well is there anything else that you'd want to tell HIV-positive people listening to the swine flu craziness that's now overwhelming the news?

For the most part, I've been reassuring my patients that they don't really have to think about this flu differently than anyone else. And that's in part because most of my patients are on HIV treatment and have undetectable viral loads and have decent CD4 counts. So for them, it really is not a special issue. It's an issue we all have to be concerned about.

So no need to panic?

No, definitely not. I mean so far this doesn't look like the kind of SARS [severe acute respiratory syndrome] or avian flu sort of pandemic that we have been worried about in recent years.

If I had to bet, I would say that this will end up being perhaps a big epidemic in numbers, but not too much worse than just a regular old flu season except that it's happening at the wrong time of year. That's what I hope we'll see, but like I said, we'll have to just see what happens as the data emerge.

I guess we'll stay tuned. I have saved the most important question for last, which is: Is it not true, sir, that you are most likely to get swine flu if you eat pork that's been imported from Mexico?

[laughs] No, you're not going to get it from eating the pig. Maybe if you're raising the pig, that might be different, but it's OK to eat it.

Dr. Gallant, thank you so much for taking the time to talk with us.

This transcript has been lightly edited for clarity.


Copyright © 2009 Body Health Resources Corporation. All rights reserved.

This podcast is a part of the series HIV News & Views. To subscribe to this series, click here.

  

This article was provided by TheBody.com. It is a part of the publication HIV News & Views.
 
See Also
Whatever Happened to H1N1 (Swine Flu) and HIV? New Answers at CROI 2010
FAQs About H1N1 Flu From The Body's "Ask the Experts" Forums
Swine Influenza and You
Preventing the Flu: Good Health Habits Can Help Stop Germs
Swine Influenza and HIV

Reader Comments:

Comment by: Andre M (LA ) Sat., Dec. 5, 2009 at 4:59 pm EST
Does the virus eat muscle mass?
Reply to this comment


Comment by: bobby d (glendel) Mon., Nov. 16, 2009 at 9:59 am EST
how do you get the h1n1?
Reply to this comment


Comment by: Six Degrees of Seperation (Kennewick, WA) Sat., Oct. 10, 2009 at 10:04 am EDT
When taking precautions of doing a good daily hygiene..it should be noted your type of soap? How strong it is versus how well you do the task of washing 20 seconds which is equal to singing in side your head Happy birthday to me twice , and the 3rd Happy birthday to me is the wiping of moisture off the hands and not touching weird locations on the face , nose and eyes afterwards. Use barrier wipes such as soft Kleenex that does not have oils embedded into it, and most of all when doing store transactions be aware of who has their cards in their hands versus handling charge cards in rude manners like in their mouths or corset/bra when they haul it out to pay for stuff.People with washing fixations will undoubtedly make their hands raw with too much washing...Make sure to be kind to yourself at home and re-moisturize the skin with a Gold bond cream or a well-balance hand oriented cream that restores the natural balance of the skin. Too much astringents will lead to chapped sore skin that will open up a whole new Dermatological need. These being transitory issues if an infection would start. Most important cough into the direct right or left shoulder of your shirt or coat so you don't fling your exhale all over the person in front of you...You will need to be careful of the cough zones between people..Also when some one has a directional sneeze that sends stuff flying! Think 7 to 10 feet a sneeze can be clocked at near 1/70th of a normal heart-beat.. So what is sneezed is very possible to be a water droplet or vapor that can hang momentarily in mid air.
Reply to this comment


Comment by: selena gomez (LA ,USA) Sun., Aug. 30, 2009 at 8:48 am EDT
i've never thought of myself dying, but when i think of it, i'm scared. i know what it is to lose someone and what if someone lost me? now that i've read this article, i'm thinking when last did i wash my hands?..ok, i'll do it now!!!
lots of luv...sel
Reply to this comment


Comment by: Steven J. Bruening (Cincinnati, Ohio) Thu., Aug. 27, 2009 at 7:51 pm EDT
Dr. Gallant:

Excellent and informative article on the swine flu case scenario. I think the totality of this argument may be summed up in the proverbial adage, "An ounce of prevention is worth a pound of cure."

Sincerely,
Steven J. Bruening
paitent of Dr. Judith Feinberg
Reply to this comment


Comment by: Sam (Alabama) Thu., Aug. 27, 2009 at 6:20 pm EDT
There is a swine flu vaccine (http://www.guardian.co.uk/world/2009/aug/27/swine-flu-vaccine/print).

Please update this story with more current information and guidelines. Thanks. Sam
Reply to this comment


Comment by: Rick (Chicago) Tue., Aug. 25, 2009 at 10:03 pm EDT
This helped me feel better. But, I'm still scared. My CD4 (last time I got checked) 11. I wasn't on meds yet and suspect it has risen. But, I was told it would take a year or so before I'm over 200. So, we'll see. I don't usually get the flu anyway. But, thanks. And Sue, I'm on Truvada too... so, thanks for that info.
Reply to this comment


Comment by: Nathan (London) Tue., Aug. 11, 2009 at 1:01 am EDT
So Marcus (Houston Texas), I am with Mark (Bristol) on this one, we already know that everyone has the same risk of infection, that isn't the issue, it's the complications resulting from infection that are the issue and not just the obvious ones like respiratory problems...anyone who has had enforced bed rest and gastrointestinal problems knows just how bad things can get....now we find there are serious issues with Tamiflu....so the truth is that Swine Flu can be a real serious health issue for HIVers....much worse than for otherwise healthy people....and it's better to tell the truth than focus on the irrelevant....let's see a list of things that CAN happen to a HIVer with Swine Flu and what, if anything can be done to mitigate them....
Reply to this comment


Comment by: Marcus (Houston, TX) Sun., Aug. 2, 2009 at 12:53 pm EDT
Mark from Bristol: You need to read the article more carefully. Dr. Gallant clearly states that HIV+ persons are more at risk for complications if they were to contract swine flu. His argument is focused on the fact that HIV+ persons are no more likely to contract the virus than HIV- persons. These are two quite distinct issues. Every HIV+ person should know that if they contract *any* illness they are generally more at risk for complications than an HIV- person with the same illness. That's just common sense, and this article does nothing to contradict that.
Reply to this comment


Comment by: George (Palm Beach, Fla) Sat., Aug. 1, 2009 at 11:16 pm EDT
Jonathan why in the world aren't you on HIV treatment? With only 23 t cells you are at risk not only for swine flu but for death, cancer and lots of other infections!! go to your nearest clinic and save your life! there are free clinics in Virginia!
(call an HIV/AIDS organization for a referral, look up one here: http://www.thebody.com/index/hotlines/other.html#Virginia)
Reply to this comment


Comment by: Jonathan (virginia) Sat., Aug. 1, 2009 at 10:00 am EDT
I have only 23 tcells and a viral load of 267,000. My white blood cells are only at 1.9 and I take no hiv meds. Am I at great risk of Swine flu?
Reply to this comment


Comment by: Sue (Essex, England) Tue., Jul. 21, 2009 at 2:56 pm EDT
I`m off work with swine flu at the moment and I am H.I.V+. I had to start Relenza last friday as Tamiflu WAS NOT COMPATABLE with my hiv drugs,- those being Truvada and Kaletra. My symptoms started with a sore throat for 3 days then neck ache on the wed evening. By thur lunchtime my legs were aching so much i was fit 2 drop. I`d already contacted my hiv Dr to see if I was ok to take Tamiflu- which he found out to be `no` and advised me to ask my G.P. for Relenza. So all I can say to other hiv+ people is check with your conultant...Take care
Reply to this comment


Comment by: Mark (Bristol) Sun., Jul. 19, 2009 at 8:26 am EDT
I think you need to do better research and update the inaccurate and dangerous conclusions in this article.

The WHO has now (July) categorized HIV as one of the 4 most "high risk groups of complications" if getting the Swine Flu and these groups are to be given priority for antivirals and vaccines.

This doesnt strike me therefore as a "dont worry you are at no more risk than the rest of the population".

In this time of lack of information and misinformation I think all doctors and so called self styled "experts" need to stop making statements that are mere opinions and have no scientific support. Your article is giving a false sense of security to all of us HIVers.
Reply to this comment


Comment by: pj (Blackpool) Tue., Jul. 14, 2009 at 8:37 am EDT
Nathan, by "no risk" they probably mean no additional risk (being HIV+) of catching swine flu. There is quite a lot now in the UK, and I guess many if not most of the population will be exposed one way or another over the next 2 months.
Avoiding contact with people might help, but is fairly impractical. A useful tip is to be scrupulous with direct contact/hand hygeine - don't touch anything you don't have to, and avoid communal toilets where taps etc could be contaminated.
I am concerned that if someone with HIV gets swine flu, it may behave in an unpredictable manner. I don't think we know how bad it might be. People should take the antivirals if available and if they fulfill the definition for flu (Fever over 38c plus 2 of the following - aches in muscles or joints; cough; sorethroat; headache; diarrhoea.
If you are on HIV drugs there might be some issues about interactions with Tamiflu (the levels might go up in your blood, potentially causing more side effects from it). HIV drug levels will be unaffected. Relenza might be preferrable option.

Reply to this comment


Comment by: Tue., Jul. 14, 2009 at 8:19 am EDT
Interesting stuff. Did you hear that there's a new strain which is resistant to the anti-flu drugs? Tamiflu etc? Found a really good website for tracking it's progress, seems to be updated every hour or so... http://www.swinefludeaths.co.uk.
Reply to this comment


Comment by: Mike (Brighton UK) Mon., Jul. 13, 2009 at 7:05 pm EDT
Thank you Joel.... rough time for us all but your words and knowledge make me feel better
Reply to this comment


Comment by: Nathan (London) Fri., Jul. 10, 2009 at 3:58 pm EDT
Doctor, you wrote: 'If there's flu going on in your community and you can avoid being in crowded places with a lot of people, that probably would help.' I live in London and there is flu here, but our public health authorities seem more concerned with keeping people calm than telling the truth. I am avoiding crowded places but am being told there is no risk!

What concerns me is that a long term survivor I have other health issues, for example I have had a DVT and Pulmonary Embolism, I fear being bed ridden in case this happens again, and how can I take meds or get other help if I am laid low with Swine flu, with fever, vomiting, diarrhoea etc. not everyone has the support they need when they are ill.

I know from experience that if I get that ill with one thing other things follow in the wake of it, e.g. the stress of it could trigger a herpes attack.
I guess what I am saying is that while its important not to catastrophize this, the vulnerable are the ones who die and suffer and there isn't enough honest information out there from clinicians and public health officials which says if your already ill this will make your pre-existing conditions potentially a lot worse or even kill you.
Reply to this comment


Comment by: David (London) Thu., Jul. 9, 2009 at 6:44 pm EDT
Sorry, i don't agree, you have actually said very little to help me.

I have a cd4 count of 113, what you are saying is that people with HIV need not worry unless they get the flu, well that's a bit of a paradox i would say.

I don't think you have any idea what the impact is on HIV positive people. All i know is that those who have died of swine flu in the US and here in the UK had according to the "authorities" "already suffered from underlying complications" I AM STILL AT A LOSS WHETHER HIV IS " AN UNDERLYING COMPLICATION" AS ARE YOU.

Government mouthpieces are not needed in the fight against HIV

Reply to this comment


Comment by: Michele C (liverpool england) Wed., Jul. 8, 2009 at 11:23 am EDT
Thankyou for the information you have provided, I feel so much better and more informed, thankyou once again
Reply to this comment


Comment by: Chris Roach (London) Wed., Jul. 8, 2009 at 1:13 am EDT
Thank you all my fears put to rest in 5 minutes of reading . great interview
Reply to this comment


Comment by: pat (nj) Wed., May. 20, 2009 at 2:19 pm EDT
Ok, I feel a little better. I came down with a fever last night 102, and now it's around 101/ I am undetectable and have a 700 cd4

I guess I will let it play out for now.
Reply to this comment


Comment by: Megan (Ft. Lauderdale, FL) Thu., May. 14, 2009 at 9:55 pm EDT
Thank you for the information. Im a middle school student and Im writing about HIV and AIDS. this was very informative and i might tell about it in my essay ( noting the body and Joel Gallant in my bibliography) even though i am not HIV + this information will be of intrest to me, my teacher, and peers. thanks.
Reply to this comment


Comment by: Kevin Bertie (Liverpool (England)) Sat., May. 9, 2009 at 10:11 am EDT
What a great informative interview!!!! It certainly put my mind at ease being an HIV+ person....I now feel much better not having to worry about contacting SWINE FLU..
Reply to this comment


Comment by: Kerry (England) Thu., May. 7, 2009 at 12:21 pm EDT
How do you know when your getting the swine flu? Does it start with a cold and get worse ?
Reply to this comment


Comment by: CJ (Allentown,PA) Sun., May. 3, 2009 at 11:21 pm EDT
thanks for the insight on this swine flu hiv relation. this was a good read and has provided relief to us in the hiv/aids community ... that's why i love this website... has all hiv/aids related information... thank you Dr. Gallant, Myles, & TheBody.com !
Reply to this comment


Comment by: Dan (In a state not yet affected) Fri., May. 1, 2009 at 9:48 pm EDT
Let me add my thanks also, I will sleep better tonight, I just read the CDC directive and to be honest it was scary. Your reassurance is relevant and timely and I will stop wondering should I call my health provider - I am sure he is swamped fielding questions.
Reply to this comment


Comment by: Fernando (Rio, Brazil) Fri., May. 1, 2009 at 7:26 pm EDT
Excellent interview, thank you!
I was really concerned about the effect this kind of flu could have on HIV + people.
Reply to this comment


Comment by: Gary (LA, calif) Fri., May. 1, 2009 at 6:06 pm EDT
Terrific interview. Thanks for staying on top of this. I feel reassured.
Reply to this comment


Comment by: (London) Thu., Apr. 30, 2009 at 6:27 pm EDT
Thank you very much...it has been very informative!
Reply to this comment


Comment by: Matthew in CMH (Columbus, OH) Thu., Apr. 30, 2009 at 2:52 pm EDT
Thank you for the coverage. I can't stand it when people get into a panic when a teeny, tiny percentage of the population gets infected with something. I have been telling my friends and co-workers to not worry about what MAY happen and just think about the present.
Reply to this comment


Comment by: dj (georgia) Thu., Apr. 30, 2009 at 11:53 am EDT
Does any of the current anti virals we take work against h1n1?
Reply to this comment


Comment by: Bruno Szota (La Rochelle, France) Thu., Apr. 30, 2009 at 7:06 am EDT
Thank you SO much for this. All i can find in the news is the typical "MILLIONS EXPECTED TO DIE!!! DONT TOUCH ANYONE!!!! DONT BREATHE!!!!"

I was so confused as to why SO many people are expected to die, when normal Flu gets treated so directly. The explanation that its a totally new strain makes sense.

Now i just have to start panicking about the fact that i work in the international department of a business school... and i've got students fleeing Mexico and coming back to study with us!!!

I'll buy some handwash and a mask, and my colleagues will say im overreacting... but it would be a pain to survive HIV but get killed off by a pig flu.
Reply to this comment


Comment by: joey (chicago) Thu., Apr. 30, 2009 at 12:05 am EDT
Thanks for the great overview
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Comment by: laurie priddy (some where in the rockies) Wed., Apr. 29, 2009 at 10:51 pm EDT
Thank you Joel, I am off to speak with some students tomorrow and kinda was a little nervous, not any more. Thank you for your commenting on this issue and heck can we call it by its real name not SWINE....the media sure does love instilling fear!!!! Much love to Joel.
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