Outcomes in HIV-infected patients admitted due to pandemic influenza

• Published in: Enfermedades infecciosas y microbiologia clinica Vol. 30; no. 10; pp. 608 - 612
• Main Authors: López-Aldeguer, José, Iribarren, José A, Valencia, Eulalia, Barquilla, Elena, Knobel, Hernando, Santos, Jesús, Lozano, Fernando
• Format: Journal Article
• Language: English
• Published: Spain Elsevier Espana 01.12.2012
• Subjects: Adult; Anti-HIV Agents - therapeutic use; Antiviral Agents - therapeutic use; CD4 Lymphocyte Count; Cohort Studies; Comorbidity; Factores pronósticos; Female; Gripe pandémica; HIV infection; HIV Infections - drug therapy; HIV Infections - epidemiology; Hospital Mortality; Humans; Infección por VIH; Infectious Disease; Influenza A H1N1; Influenza A Virus, H1N1 Subtype; Influenza AH1N1; Influenza Vaccines; Influenza, Human - drug therapy; Influenza, Human - epidemiology; Inpatients - statistics & numerical data; Intensive Care Units - statistics & numerical data; Length of Stay; Male; Middle Aged; Obesity - epidemiology; Oseltamivir - therapeutic use; Pandemic influenza; Pandemics; Prognostic factors; Respiratory Tract Diseases - epidemiology; Sepsis - epidemiology; Smoking - epidemiology; Spain - epidemiology; Symptom Assessment; Treatment Outcome; Vaccination - statistics & numerical data; Spain; Influenza AH1N1; Pandemic influenza; Influenza A H1N1; Gripe pandémica; Infección por VIH; HIV infection; Factores pronósticos; Prognostic factors
• ISSN: 0213-005X; 1578-1852
• DOI: 10.1016/j.eimc.2012.02.007

Abstract Purpose To determine the clinical, epidemiological and prognostic factors of HIV-infected patients with influenza A H1N1 admitted to hospital. Methods The study population was HIV infected patients with confirmed influenza infection admitted to hospital in a multicenter cohort. We analyzed demographic data, comorbid conditions, severe events (bronchopneumonia, respiratory insufficiency, respiratory distress, sepsis, admission to intensive care unit, death) and outcome. Data were analyzed using descriptive statistics. Proportions were compared using the χ2 test or Fisher exact test, when applicable. Quantitative variables were compared using the Student t test or Mann–Whitney test. Prognostic impact was analyzed using logistic regression. Results A total of 43 patients, of whom 62.8% were male, were included from 22 hospitals. The mean age was 43.3 years (interquartile range [IQR], 38.4–48.4). HIV was diagnosed for a mean of 14.5 years (IQR, 8.4–20.3). CD4 lymphocyte was <200 cells/μL in 38%; 85.7% were on antiretroviral therapy, and 66.7% virologically suppressed. Comorbid conditions were hepatitis B or C (74.4%), smoking (67.4%), chronic obstructive pulmonary disease (30.2%), asthma (14%), and obesity (8.6%). Seven patients had received seasonal influenza vaccination, and 2 the H1N1 vaccine. Cough (100%), fever (93%), gastrointestinal disorders (27.9%) or general – myalgia, general malaise – (67.4%) were the presenting symptoms. These were severe in 24 (55.8%) with 7 (16.3%) requiring intensive care. Two patients died. A lower CD4 lymphocyte count was associated with bacterial infection ( P = .063) and longer hospital stay ( P = .007). Early oseltamivir reduced severe cases (OR, 4.5; 1.1–18.3; P = .035). Conclusions HIV-infected patients admitted to hospital due to influenza A H1N1 had severe morbidity. Low CD4 lymphocytes correlated with longer hospitalization and bacterial infections. Early oseltamivir treatment reduced severe symptoms.