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The Latest on H1N1 (Swine Flu) and HIV/AIDS

October 21, 2009

If you feel like swine flu (or H1N1, as we're supposed to be calling it) never actually left us here in the U.S., you wouldn't be far off. Flu season in the U.S. normally runs from late November through the end of March. However, thanks almost entirely to H1N1, the 2008-2009 flu season ran into the beginning of the summer, and the 2009-2010 season has already begun.

So where do we stand on H1N1 right now? And what have we learned in the past few months that's especially important for people with HIV, or those who are close to (or care for) people with HIV?

As fortune would have it, the White House Office of Public Engagement arranged a series of conference calls for health care professionals a couple of weeks ago, each one focusing on a different "risk group": there was one for people with diabetes, one for people with heart problems, and yes, one for people with HIV.

Here are some of the key points that came out of the call on H1N1 and HIV, which took place on Oct. 9. It featured talks and a question-and-answer period with two doctors: Tom Shimabukuro, M.D., a vaccine expert with the U.S. Centers for Disease Control and Prevention (CDC); and John Brooks, M.D., who works on the CDC's HIV prevention team.

  • If you have HIV or provide care for someone who does, do not get the nasal-spray version of a flu vaccine. Wait for the injection. Each year, there are usually two versions of a flu vaccine: the "live attenuated" version, which is a nasal spray containing live bits of actual flu virus, and the "inactive" version, which is injected using a syringe and contains only dead bits of the flu virus. The inactive version is the one you want if you have HIV or even if you are providing care for someone with HIV, since the live version may carry some risk of actually infecting you with the virus it's supposed to prevent.

    As I write this, the H1N1 vaccine is still just beginning to make its way to health care centers throughout the U.S., and most of the H1N1 vaccine being delivered is in nasal spray form, according to Dr. Shimabukuro. As October turns to November, more and more of the inactive, injected version of the vaccine will become available -- and that'll be the time to get your vaccination. Check out and click on the "Flu Shot Locator" link to see whether any clinics, doctors offices or the like are offering the shot near you.

  • In the U.S. right now, virtually all the flu that has occurred H1N1 flu. During the week of Sept. 27 to Oct. 3, for instance, H1N1 was found in 99 percent of all those who tested positive for the flu and who had their flu virus analyzed to determine what type of virus it was.

  • The symptoms of H1N1 are no different than they are for the regular seasonal flu. They include any of these (usually several at once): fever, chills, sore throat, stuffed up or runny nose, coughing, aching, tiredness, and possibly even vomiting or diarrhea. Basically, you feel like crap. In a normal year, more than 200,000 people in the U.S. go to a hospital because of the flu, and this season we've got an extra type of flu on top of the regular seasonal one.

    This wasn't mentioned during the conference call, but it's worth noting a couple of key ways in which the flu -- be it the seasonal variety or H1N1 -- is different from a cold. They're both caused by viruses, and the symptoms generally are quite similar, but flu symptoms are generally more severe and last longer (often more than week, whereas a cold is usually wrapping up when it reaches a week old). You're also much less likely to have a fever if all you have is a cold. When it comes to H1N1, two symptoms in particular -- vomiting and diarrhea -- have been reported more often than with seasonal flu. (Neither of those symptoms is likely if you just have a cold.)

  • You get H1N1 the same way you get the regular seasonal flu. It usually happens when someone who has the flu coughs or sneezes near you, and you breathe the virus in. It can also happen when you touch a surface that has live flu viruses on it, and then put that finger into your eyes, nose or mouth.

  • To be on the safe side, everyone with HIV should get both a H1N1 and regular seasonal flu vaccine, regardless of CD4 count or viral load. The flu vaccine situation is a lot simpler if you have HIV and are under the age of 65, because you're automatically on the priority list for both the H1N1 vaccine and the regular seasonal flu vaccine. (People 65 and older are not considered at high risk for H1N1, so they are not on the H1N1 vaccine priority list. However, they are on the priority list for the regular seasonal flu vaccine -- all HIV-positive people are, regardless of age.)

    Even if your CD4 count is robust -- say, over 1,000 -- the recommendation is still to get the shot. "There's just not enough data for us to make a recommendation based on CD4 cell count, so we make it for all persons with HIV," explained Dr. Brooks. "We want to be conservative and do the right thing."

    The order of the H1N1 and seasonal flu shots doesn't matter. You can get one weeks before the other, or get them both at the same time. However, if you decide to get your seasonal flu vaccine now, you'll have to go back and get the H1N1 vaccine when it's available as an injection, since it's only available as a nasal spray now.

  • The H1N1 shot is just as safe as the seasonal flu shot. Even though H1N1 is a new strain of flu, no corners were cut in creating the vaccine for it in time for this flu season, Dr. Shimabukuro said. Five different companies are making H1N1 vaccine for the U.S. this year, and all of them are approved and licensed.

    "The licensing process is similar to the way flu vaccines are made every year," Dr. Shimabukuro said. "There's a long history of use of influenza vaccine and it has an excellent safety profile. We do not anticipate that there would be any more adverse events from the H1N1 vaccine than from the regular seasonal vaccine." Those "adverse events" are usually pretty mild, involving just some soreness around where the shot was given. Sometimes the shot can cause some mild flu-like symptoms for a day or two.

  • The great flu paradox: It is not more common in HIVers, but it can be more severe. Research on the flu -- including H1N1 flu -- shows that people who get severely ill from the flu tend to have one or more "underlying health conditions," a general term used to describe any of a number of diseases or states of being. A full listing is available online, but the bottom line is that they include having a "weakened immune system" -- a state that all HIVers are lumped into, even if they have a CD4 count over 500.

  • Protect yourself from pneumococcal pneumonia: Make sure your Pneumovax shots are up to date. You can get a booster shot every five years, and Dr. Brooks of the CDC highly recommends them, since pneumonia and the flu can make one another worse. "Not only are persons with HIV more susceptible to this infection that can cause pneumonia, but this is a form of bacterial pneumonia that also commonly complicates the course of influenza, and persons who have suffered influenza are predisposed to getting pneumococcal disease," he explained on the conference call. People with HIV are at a higher risk for developing pneumococcal pneumonia, especially if they have a CD4 count under 200.

If you want to stay up on the very latest developments regarding H1N1, visit's H1N1 page. The government has its own resources, of course: A Web site conveniently named (where you can sign up to receive e-mail notifications whenever part of the site changes) or a health hotline at 1.800.CDC.INFO (that's 1.800.232.4636).

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This article was provided by TheBody.
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


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