tetano
Editor, Senior Moderator
By Michael Smith, North American Correspondent, MedPage Today
Published: February 20, 2010
Reviewed by Barry S. Zingman, MD; Professor of Clinical Medicine, Albert Einstein College of Medicine, Bronx, NY. SAN FRANCISCO -- HIV infection did not make the H1N1 pandemic flu more dangerous, a researcher said here.
And catching the pandemic flu did not worsen the progression of HIV, according to Esteban Martinez, MD, of the Hospital Clinic in Barcelona.
The finding comes from an analysis of 623 people with confirmed H1N1 flu -- including 56 who were HIV-positive -- admitted to his institution last fall, Martinez reported at the Conference on Retroviruses and Opportunistic Infections.
Martinez said the HIV-positive patients were mainly male, older, and smokers -- reflecting the population treated at his hospital and suggesting the flu was not attacking any particular segment of HIV-infected people.
Clinical features were generally similar, he said, with two exceptions:
* 37% of HIV-positive flu patients had digestive symptoms, compared with 18% of HIV-negative patients, a difference that was significant at P=0.004.
* HIV-positive patients were less likely to have pneumonia and respiratory failure -- 9% and 9%, respectively, versus 25% and 21%. The differences were significant at P=0.01 and P=0.04.
Rates of complications after the flu diagnosis were similar -- 12% for HIV-positive patients versus 11%. No HIV-positive flu patients died, although 2% of the others in the cohort did.
Among the HIV-positive patients, median CD4 counts and HIV viral loads did not differ before and after the flu.
The findings are reassuring, said Robert Schooley, MD, of the University of California San Diego, who moderated a session at which the study was presented.
"With the exception of a few outliers," he told MedPage Today, "people with HIV infection do about as well as most of the rest of the population."
On the other hand, Schooley said, the lung symptoms of the pandemic flu -- apparently lower in HIV patients -- arise from inflammation perhaps driven by an "exuberant immune response." If that's the case, Schooley said, "HIV may be something that moderates the response."
But he noted the study may be subject to some biases, including the fact that people with HIV are more conscious of their health and might have been more likely to seek care when they had flu-like symptoms.
Martinez's study was part of a late-breaking themed discussion on the interaction of the pandemic flu with HIV. A second study looked at clinical features of HIV-positive people with the flu in Mexico City. It also found a typical disease course -- as long as the CD4 count of patients was above 200.
Among those patients, the course of the disease and the response to treatment were typical, according to Gustavo Reyes-Ter?n, MD, of the Mexican National Institute for Respiratory Diseases.
But in patients with a low CD4 count, he reported, other infections masked the symptoms of the flu, resulting in longer times to treatment and higher mortality.
Indeed, among those with an opportunistic infection, he said, the probability of requiring inpatient care was increased by a factor of 24.5 and the likelihood of needing mechanical ventilation by a factor of 19.7, compared with those without such a disease. The differences were significant at P=0.0004 and P=0.007, respectively.
Those on highly active antiretroviral therapy, on the other hand, appeared to be protected from the most severe disease, he said.
Of the 128 HIV-positive patients referred to the institute for treatment of respiratory illness, 27 tested positive for the pandemic flu, Reyes-Ter?n said.
Of those, 14 (or 51%) needed inpatient care, and six (or 22%) died -- rates that were not significantly different from those seen among people suffering from other respiratory illnesses, where 68 (or 67%) needed inpatient care and 14 (or 13.9%) died.
http://www.medpagetoday.com/MeetingCoverage/CROI/18590
Published: February 20, 2010
Reviewed by Barry S. Zingman, MD; Professor of Clinical Medicine, Albert Einstein College of Medicine, Bronx, NY. SAN FRANCISCO -- HIV infection did not make the H1N1 pandemic flu more dangerous, a researcher said here.
And catching the pandemic flu did not worsen the progression of HIV, according to Esteban Martinez, MD, of the Hospital Clinic in Barcelona.
The finding comes from an analysis of 623 people with confirmed H1N1 flu -- including 56 who were HIV-positive -- admitted to his institution last fall, Martinez reported at the Conference on Retroviruses and Opportunistic Infections.
Martinez said the HIV-positive patients were mainly male, older, and smokers -- reflecting the population treated at his hospital and suggesting the flu was not attacking any particular segment of HIV-infected people.
Clinical features were generally similar, he said, with two exceptions:
* 37% of HIV-positive flu patients had digestive symptoms, compared with 18% of HIV-negative patients, a difference that was significant at P=0.004.
* HIV-positive patients were less likely to have pneumonia and respiratory failure -- 9% and 9%, respectively, versus 25% and 21%. The differences were significant at P=0.01 and P=0.04.
Rates of complications after the flu diagnosis were similar -- 12% for HIV-positive patients versus 11%. No HIV-positive flu patients died, although 2% of the others in the cohort did.
Among the HIV-positive patients, median CD4 counts and HIV viral loads did not differ before and after the flu.
The findings are reassuring, said Robert Schooley, MD, of the University of California San Diego, who moderated a session at which the study was presented.
"With the exception of a few outliers," he told MedPage Today, "people with HIV infection do about as well as most of the rest of the population."
On the other hand, Schooley said, the lung symptoms of the pandemic flu -- apparently lower in HIV patients -- arise from inflammation perhaps driven by an "exuberant immune response." If that's the case, Schooley said, "HIV may be something that moderates the response."
But he noted the study may be subject to some biases, including the fact that people with HIV are more conscious of their health and might have been more likely to seek care when they had flu-like symptoms.
Martinez's study was part of a late-breaking themed discussion on the interaction of the pandemic flu with HIV. A second study looked at clinical features of HIV-positive people with the flu in Mexico City. It also found a typical disease course -- as long as the CD4 count of patients was above 200.
Among those patients, the course of the disease and the response to treatment were typical, according to Gustavo Reyes-Ter?n, MD, of the Mexican National Institute for Respiratory Diseases.
But in patients with a low CD4 count, he reported, other infections masked the symptoms of the flu, resulting in longer times to treatment and higher mortality.
Indeed, among those with an opportunistic infection, he said, the probability of requiring inpatient care was increased by a factor of 24.5 and the likelihood of needing mechanical ventilation by a factor of 19.7, compared with those without such a disease. The differences were significant at P=0.0004 and P=0.007, respectively.
Those on highly active antiretroviral therapy, on the other hand, appeared to be protected from the most severe disease, he said.
Of the 128 HIV-positive patients referred to the institute for treatment of respiratory illness, 27 tested positive for the pandemic flu, Reyes-Ter?n said.
Of those, 14 (or 51%) needed inpatient care, and six (or 22%) died -- rates that were not significantly different from those seen among people suffering from other respiratory illnesses, where 68 (or 67%) needed inpatient care and 14 (or 13.9%) died.
http://www.medpagetoday.com/MeetingCoverage/CROI/18590