A recent Congressional briefing sponsored by The Foundation for AIDS Research (amfAR) examined the impact of H1N1 influenza (“swine flu”) on patients living with HIV and AIDS. Topics of discussion included prevention, treatment, and the need for research exploring the effects of H1N1 on HIV/AIDS patients.

About H1N1

Since its detection in the United States in April 2009, H1N1 “swine flu” has infected an estimated 50 million people, and has lead to approximately 10,000 deaths according to the Centers for Disease Control (CDC).

Over the following months, the CDC continued to update its recommendations regarding H1N1 flu as they were able to gather more information (for the most recent recommendations for HIV-positive individuals, see related Beacon News).

H1N1 is spread through person-to-person contact, often by sneezing or coughing, similar to transmission of the seasonal flu virus. Symptoms of the H1N1 flu and the seasonal flu both include a cough, sore throat, runny nose, body aches, headache, chills, tiredness, and sometimes fever, vomiting, and diarrhea.

Although the seasonal flu appears in different strains every year, H1N1 flu currently has only one strain. Compared to the seasonal flu, H1N1 is very contagious, and affects younger people more.

There are certain groups of people who are more at risk for complications from H1N1, including pregnant women, young children, and people with weakened immune systems, such as those with HIV and AIDS.

In an interview, Senior Policy and Medical Advisor at amfAR Dr. Susan Blumenthal said, “So far, [H1N1 influenza] does not appear highly lethal, but what’s worrisome is that it’s affecting young people and pregnant women and people who have underlying medical conditions, such as HIV/AIDS.”

Prevention

In order to prevent contracting H1N1 influenza, HIV patients should continue to maintain a healthy lifestyle, which includes taking all antiretroviral medications. In addition, they should make sure to get vaccinated for both the seasonal and H1N1 influenzas.

Frequent hand washing with soap and water can help prevent the transmission of the virus. When coughing or sneezing, individuals should always do so in the crook of their arms, or into a tissue that should later be disposed. People at risk for H1N1 flu should avoid places with large crowds. If this is not possible, they should make certain to wear a face mask when in contact with others.

Vaccines

In September of this year, the FDA approved two forms of the H1N1 flu vaccine: the injectable intramuscular vaccine and the nasal spray vaccine. Both forms contain H1N1 virus; however, the injectable form contains the killed virus, while the nasal spray form contains weakened live virus.

Individuals with HIV and AIDS should only take the injectable form, as recommended by the CDC.

Note that only HIV-infected people within the ages of 24-65 are currently on the priority list for receiving an H1N1 vaccine. This group is considered most at risk; individuals 65 and older, including those with HIV, are considered to be at lower risk for contracting the virus.

The CDC also recommends that people with HIV make sure that all their vaccinations are up to date, and that they have been vaccinated against Streptococcus pneumoniae, which causes bacterial pneumonia and can be a complication of flu infection.

Treatment

H1N1 “swine flu” can be treated with the antiviral drugs Relenza (zanamivir) or Tamiflu (oseltamivir). These drugs reduce the severity of the symptoms associated with the illness and can also improve survival rates.

If symptoms of H1N1 flu are present, it is important to start antiviral treatment within 48 hours of the onset of symptoms. It is not necessary to wait for laboratory confirmation of influenza in order to begin antiviral treatment. Individuals with a suspected H1N1 flu infection should contact their doctor to discuss whether treatment with antivirals is appropriate.

No adverse interactions have been reported between antiretrovirals and Relenza or Tamiflu.

In some cases, HIV-positive patients might be given antivirals as a preventive measure (called “chemoprophylaxis”), if they have been in close contact with someone who has likely been exposed to H1N1 flu.

Research Regarding H1N1 Flu And HIV/AIDS

So far, there is no evidence that people with HIV are more likely to get H1N1 flu; however, the risk for complications may be greater in HIV-positive individuals.

According to Dr. Blumenthal, research is currently underway to determine how H1N1 will impact individuals included in the CDC’s risk groups.

Additionally, The National Institute of Allergy and Infectious Diseases is currently looking for HIV-positive volunteers to participate in research to determine the most effective dosage of the H1N1 vaccine in HIV-infected patients (see related Beacon News) and HIV-infected pregnant women and children (see related Beacon News).

For more information, please see the amfAR Web site and the CDC’s H1N1 Information Page for people who are HIV-positive.