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January 2010
Patient Care and Science
Novel Influenza Strain Raises Questions for Care of HIV Patients

More research is needed, but data thus far do not indicate that people living with HIV are at substantially greater risk than others for infection with the 2009 novel H1N1 influenza strain. These patients, however, may have a greater risk for more severe illness if they do become infected with H1N1. These were two of the takeaway points presented by a panel of experts at a briefing on H1N1 and HIV/AIDS held in December by amfAR, The Foundation for AIDS Research, in Washington, D.C.

The few available data have not indicated an increased susceptibility to influenza infection, including H1N1, among persons living with HIV, said John T. Brooks, MD, leader of the clinical epidemiology team at the Centers for Disease Control and Prevention (CDC)’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. However, the prevalence of HIV-positive patients among those hospitalized for H1N1 does suggest a higher risk for severe influenza-related illnesses, said Dr. Brooks, who highlighted the need for prospective, observational studies of patients hospitalized with confirmed cases of H1N1.

Several ongoing U.S. studies should help answer questions about how different HIV populations, such as pregnant women and children, respond to the H1N1 vaccine, according to Sharon Nachman, MD, FIDSA, professor of pediatrics, chief of pediatric infectious diseases, and associate dean for research at Stony Brook University Medical Center in New York. Because of HIV patients’ reduced immune response to vaccines in general, these studies are examining the safety and immunogenicity of double the H1N1 vaccine dose recommended for others.

These research findings, however, may not be applicable in other parts of the world, such as Africa, where CD4 cell counts among those living with HIV are typically not as high as in developed countries with better access to antiretroviral treatment, noted Dr. Nachman, who also serves on HIVMA’s Board of Directors as the Pediatric Infectious Diseases Society liaison.

Another panelist, Adriana Weinberg, MD, FIDSA, professor of pediatrics, medicine, and pathology, and director of the Clinical Virology Laboratory at University of Colorado in Denver, outlined treatment questions raised by H1N1. It’s not known if the antiviral treatment doses and intervals typically used to treat H1N1 are appropriate for HIV patients, Dr. Weinberg said. Potential interactions among these treatments and antiretroviral drugs are another area needing more study.

Additional research is also needed to explore how immunosuppressed patients, such as those with HIV, shed the H1N1 virus. These patients may shed the H1N1 virus longer than others who are infected with the novel influenza strain, raising concerns for potential increased transmission of H1N1 virus by HIV-positive individuals with H1N1 infection, Dr. Weinberg said.

Slides from the briefing and a consumer fact sheet are available on amfAR’s website.  Updated information for physicians about seasonal and H1N1 influenza is also available on IDSA’s website.
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