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Clin Infect Dis. (2012) doi: 10.1093/cid/cis549 First published online: June 19, 2012
Influenza-related mortality among adults age 25-54 years with AIDS in South Africa and the United States of America
Cheryl Cohen1,2,
Lone Simonsen3,4,
Jeannette Sample4,
Jong-Won Kang3,5,
Mark Miller3,
Shabir A. Madhi6,
Michael Campsmith7, and
Cecile Viboud3
+ Author Affiliations
1National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
2School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
3Fogarty International Centre, National Institutes of Health, Maryland, United States of America
4Department of Global Health, George Washington University, Washington DC, United States of America
5Department of Preventive Medicine, College of Medicine, Chungbuk National University, Korea
6Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases; University of the Witwatersrand; Johannesburg; South Africa
7Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
Corresponding author: Cheryl Cohen, Epidemiology and Surveillance Unit, National Institute for Communicable Diseases, Private Bag X4, Sandringham, 2131, Gauteng, South Africa, Telephone: 27 11 386 6593. Fax: 27 11 882 9979. E-mail: cherylc@nicd.ac.za
Alternate contact: Cecile Viboud, Fogarty International Centre, National Institutes of Health, Maryland, United States of America, Telephone: +1 301 496 2146 Fax: +1 301 496 8496 E mail: viboudc@mail.nih.gov
Abstract
Background. Data are limited on HIV-associated influenza burden in sub-Saharan Africa and the impact of highly active anti-retroviral therapy (HAART). We compared influenza-related mortality in adults with AIDS in South Africa and the United States (US) in the pre-HAART era and evaluated mortality trends following HAART introduction in the US.
Methods. Monthly all-cause and pneumonia and influenza (P&I) mortality rates were compiled for adults with AIDS aged 25-54 years in South Africa (1998-2005) and the US (pre-HAART era: 1987-1994; HAART era: 1997-2005). We estimated influenza-related deaths as excess mortality above a model baseline during influenza epidemic periods. Influenza-related mortality rates in adults with AIDS were compared to age peers in the general population and seniors ≥65 years.
Results. In the US pre-HAART, influenza-related mortality rates in adults with AIDS were 150- (95% confidence interval [CI] 49-460) and 208- (95%CI 74-583) times greater than in the general population for all-cause and P&I respectively and 2.5- (95%CI 0.9-7.2) and 4.1- (95%CI 1.4-13) times higher than in seniors. Following HAART introduction, influenza-related mortality in adults with AIDS dropped 3-6 fold but remained elevated compared to the general population (all cause relative risk (RR)=44 (95%CI 16-121); P&I RR=73 (95%CI 47-113)). Influenza-related mortality in South African adults with AIDS in recent years was similar to that in the US in the pre-HAART era.
Conclusions. Adults with AIDS experience substantially elevated influenza-associated mortality which declines with widespread HAART introduction but does not disappear. These data support increased access to HAART and influenza vaccination for HIV-infected adults.
Influenza-related mortality among adults age 25-54 years with AIDS in South Africa and the United States of America
Cheryl Cohen1,2,
Lone Simonsen3,4,
Jeannette Sample4,
Jong-Won Kang3,5,
Mark Miller3,
Shabir A. Madhi6,
Michael Campsmith7, and
Cecile Viboud3
+ Author Affiliations
1National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
2School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
3Fogarty International Centre, National Institutes of Health, Maryland, United States of America
4Department of Global Health, George Washington University, Washington DC, United States of America
5Department of Preventive Medicine, College of Medicine, Chungbuk National University, Korea
6Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases; University of the Witwatersrand; Johannesburg; South Africa
7Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
Corresponding author: Cheryl Cohen, Epidemiology and Surveillance Unit, National Institute for Communicable Diseases, Private Bag X4, Sandringham, 2131, Gauteng, South Africa, Telephone: 27 11 386 6593. Fax: 27 11 882 9979. E-mail: cherylc@nicd.ac.za
Alternate contact: Cecile Viboud, Fogarty International Centre, National Institutes of Health, Maryland, United States of America, Telephone: +1 301 496 2146 Fax: +1 301 496 8496 E mail: viboudc@mail.nih.gov
Abstract
Background. Data are limited on HIV-associated influenza burden in sub-Saharan Africa and the impact of highly active anti-retroviral therapy (HAART). We compared influenza-related mortality in adults with AIDS in South Africa and the United States (US) in the pre-HAART era and evaluated mortality trends following HAART introduction in the US.
Methods. Monthly all-cause and pneumonia and influenza (P&I) mortality rates were compiled for adults with AIDS aged 25-54 years in South Africa (1998-2005) and the US (pre-HAART era: 1987-1994; HAART era: 1997-2005). We estimated influenza-related deaths as excess mortality above a model baseline during influenza epidemic periods. Influenza-related mortality rates in adults with AIDS were compared to age peers in the general population and seniors ≥65 years.
Results. In the US pre-HAART, influenza-related mortality rates in adults with AIDS were 150- (95% confidence interval [CI] 49-460) and 208- (95%CI 74-583) times greater than in the general population for all-cause and P&I respectively and 2.5- (95%CI 0.9-7.2) and 4.1- (95%CI 1.4-13) times higher than in seniors. Following HAART introduction, influenza-related mortality in adults with AIDS dropped 3-6 fold but remained elevated compared to the general population (all cause relative risk (RR)=44 (95%CI 16-121); P&I RR=73 (95%CI 47-113)). Influenza-related mortality in South African adults with AIDS in recent years was similar to that in the US in the pre-HAART era.
Conclusions. Adults with AIDS experience substantially elevated influenza-associated mortality which declines with widespread HAART introduction but does not disappear. These data support increased access to HAART and influenza vaccination for HIV-infected adults.
