HIV-1-infected individuals with suspected A/H1N1 influenza at the São Paulo STD/AIDS Reference
A.T. Viso1, M.L. Mello1, L.F. Jamal1, R.A. Fraissat1, M.A. Hong2, N.M.L. Rodrigues1, R.C.S. Oliveira1, S. Araujo1, A. Luchs2, T.G. Sampaio1, S.Q. Rocha1, R.A. Souza1, M.C. Gianna1, L.F.d.M. Brigido2
1Centro de Referência e Treinamento em DST/Aids, São Paulo, Brazil, 2Instituto Adolfo Lutz/Secretaria de Estado da Saúde de São Paulo, São Paulo, Brazil
Background: Brazil and others South America countries had experienced early influenza A/H1N1-2009 pandemic that had shown a greater transmissibility and atypical photogenic features compared to seasonal cases. Its evolution among people living with HIV/AIDS was a major concern and studies to subsidize next season impact are limited. Our study evaluates the clinical evolution of influenza A/H1N1 among HIV-infected individuals.
Methods: Retrospective evaluation of HIV-1-infected patients presenting with flu symptoms at the CRT Fast Track Clinic (CRT-PA). Cases were managed according to the institutional protocol, including collection of oropharyngeal swab for influenza A (H1N1 or seasonal) virus diagnosis, performed by a CDC-modified RT-PCR protocol.
Results: From July 15th to November 10th, 2009, 113 individuals HIV-1(+) with flu symptoms were seen at the CRT-PA. All cases were tested by RT-PCR, and 104 results were conclusive. Thirty female patients and 74 male were seen; 33% were 25 to 39, and 61% 40 to 59 years old. Among them, 20 (19.2%) were positive for A/H1N1-2009, 7 (6.7%) for seasonal virus, and 77 (74%) negative for both. Most patients (96%) received Oseltamivir at entry. All the 38 (34%) patients that needed inpatient care had good clinical outcome, without the need for respiratory care. No fatalities were observed. Among 76 cases with a CD4-T cell count from the past 6 months before the beginning of symptoms, 19 (25%) were H1N1+. Among those, 3% had a CD4-T cell count >500 cells/mm3, 56.4% 350-499 cells/mm3, 11.1% 200-349 cells/mm3 and, 18.2% < 200 cells/mm3.
Conclusions: The positive rates of confirmed A/H1N1 in HIV-positive patients were similar to HIV negative individuals reported by both State and National databases. Albeit immunocompromised, the clinical outcome among these HIV+ individuals with access to oseltamivir was benign.
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