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CDC issues guidance for HIV patients regarding H1N1 flu virus
The Centers for Disease Control and Prevention (CDC) of Atlanta, GA, has published interim guidance for clinicians regarding management of patients with HIV who have been exposed to, or who have contracted the swine influenza (H1N1 virus).
The guidance, issued at the end of April, 2009, is titled, "Interim Guidance — HIV-Infected Adults and Adolescents: Considerations for Clinicians Regarding Swine-Origin Influenza A (H1N1) Virus." It's available online at http://www.cdc.gov/swineful/guidance_HIV.htm.
"The recommendations we give are for today, and what we know is things can change," says John T. Brooks, MD, a medical epidemiologist who leads the HIV clinical epidemiology team at the Centers for Disease Control and Prevention (CDC) in Atlanta, GA.
"The CDC and other agencies are looking closely at trends in the epidemiology of the virus to see whether there's evidence of it becoming more virulent," Brooks adds.
The CDC cautions HIV patients and their providers that any influenza carries potential risks for HIV-infected persons, particularly for people with low CD4 cell counts, who are at higher risk for viral and bacterial lower respiratory tract infections and recurrent pneumonias.
Adults and adolescents infected with HIV experience more severe complications from seasonal influenza, so they're also at higher risk for swine influenza complications, the CDC states.
Here is a brief summary of the recommendations:
• Clinical Presentation: HIV-infected patients with Influenza A (H1N1) virus would present with typical acute respiratory illness, including cough, sore throat, rhinorrhea, fever, headache, and muscle aches.
Patients with low CD4 cell counts might have a rapidly-progressing illness that is complicated by a secondary bacterial infection, such as pneumonia. If their flu is suspected to be the H1N1 strain, then a specimen should be obtained and tested. If the specimen tests positive for unsubtypeable influenza A virus, then it should be sent to the state public health laboratory for additional testing.
HIV patients who are experiencing signs and symptoms of the flu or who have been exposed to someone with a confirmed, probable or suspected case of influenza infection, whether it is seasonal flu or H1N1 flu, should consult their doctor for evaluation about whether they should receive anti-influenza treatment or prophylaxis.
• Treatment and chemoprophylaxis: The currently circulating swine-origin influenza A (H1N1) virus is sensitive to the neuraminidase inhibitor antiviral medications zanamivir and oseltamivir, but it's resistant to adamantane antiviral medications, amantadine and rimantadine.
HIV patients who meet current case-definitions for confirmed, probable, or suspected swine-origin influenza A (H1N1) infection should receive empiric antiviral treatment. Those HIV patients who have been in close contact with probable or confirmed cases of this particular flu strain should receive antiviral chemoprophylaxis.
Antiviral treatment with zanamivir or oseltamivir should be initiated as soon as possible after the onset of influenza symptoms. The benefits are greatest if it is started within 48 hours of onset. The treatment is given for five days, and if a prophylaxis is administered, the treatment is for 10 days after last exposure.
Clinicians should monitor the treated patient closely and consider whether to extend therapy based on the course of illness.
There have been no adverse effects reported among HIV patients from the anti-influenza treatment, and there are no absolute contraindications for co-administration of the flu drugs with antiretroviral medications.
• Other ways to reduce risk for HIV-infected adults and adolescents: The vaccine is not currently available, but these steps can reduce risk of exposure:
- Hand-wash frequently;
- Cover coughs;
- Keep ill persons home except to seek medical care;
- Minimize contact with others in household who might have the flu;
- Voluntarily home quarantine members of households with confirmed or probable swine flu cases;
- Reduce unnecessary social contacts and avoid crowded settings;
- Maintain one's health and adhere to prescribed antiretroviral treatment.