Paper # 803LB|
Clinical Features of Subjects Infected with HIV and H1N1 Influenza Virus
Gustavo Reyes-Terán*, D de la Rosa-Zamboni, C Ormsby, J Vázquez-Pérez, Y Ablanedo-Terrazas, R Vega-Barrientos, M Gómez-Palacio, A Murakami-Ogasawara, D Romero-Rodríguez, and S Ávila-Ríos
Inst Natl de Enfermedades Respiratorias, Mexico City, Mexico
Background: A novel pandemic influenza A(H1N1) virus
was isolated in 2009. Considering that individuals infected by HIV are acknowledged
as vulnerable populations during an influenza pandemic, the current study was
aimed at analyzing the impact of H1N1 infection in the HIV-infected population.
Methods: Procedures included a medical history, physical
examination, routine laboratory tests, cultures from body fluids, bronchoscopy
with bronchoalveolar lavage, imaging studies and nasopharyngeal swabs. Infection
by 2009 H1N1 was assessed by RT-PCR. ORs, Fisher´s exact test and Wilcoxon’s
rank sum tests were used to evaluate effects.
Results: Of 22 HIV+ and 2009 A(H1N1)+ patients
(2 Female, median age 34), 12 required hospitalization, 7 required mechanical
ventilation (MV), and 5 died. Median time from onset was 11 days (IQR 4-15), compared
to the reported 6 days in non-HIV+ population seen at our institution. Sequential
samples taken at different intervals after 5 days with 75 mg oseltamivir treatment
revealed that 3/5 patients had detectable virus shedding at day 7, and 1/10 at
day 11, confirmed by RT-PCR. 11 patients were on successful HAART at symptoms
onset, which reduced the probability of MV (OR=0.09, p=0.03) and hospitalization
(OR=0.1, p=0.03). Having an opportunistic infection raised the probability of
requiring hospitalization (OR>24.5, p=0.0004), MV (OR=19.7, p=0.007), and
having a longer time from onset (p=0.0008). CD4+ cell counts of all patients
had a median of 155 (IQR 57-394), and hospitalized patients had a lower count
(p=0.015). Patients with CD4+ counts under 200 had a higher median time from
onset of symptoms to hospital valuation (15 days) than those with higher counts
(7 days, p=0.046).
Conclusions: The evolution period of influenza
disease in HIV-infected subjects was extended when compared with previous
reports in non HIV-infected subjects, and appears to be
associated with CD4+ counts. Shedding of influenza virus in some HIV-infected
subjects remained even after 5 days of treatment with oseltamivir. This is
relevant since persistent viral replication after antiviral therapy has been linked
to the risk of emergence of resistance. The presence of OIs suggests a more
complicated course of the disease as indicated by a higher number of patients
in need of hospitalization, mechanical ventilation, and longer time from onset.
HAART appears to have a protective effect on the severity of the disease.