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HIV Did Not Worsen H1N1 Severity in Spanish Case-Control Study
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17th Conference on Retroviruses and Opportunistic Infections, February 16-19, 2010, San Francisco
Mark Mascolini
HIV-infected people with H1N1 influenza tended to do as well as HIV-negative people with the new flu, according to a 200-person case-control comparison in Barcelona [1]. In fact, people with HIV and H1N1 spent less time in the hospital than H1N1 patients without HIV, and the HIV group recovered from the flu more quickly. In addition, H1N1 did not adversely affect control of HIV.
Esteban Martinez and coworkers focused on 56 HIV-infected adults diagnosed with H1N1 from April 26 to December 6, 2009. For every person with HIV, they enrolled three consecutive HIV-negative adults diagnosed with H1N1 in the same week. The two groups had parallel peaks in H1N1 diagnosis in late August and November. Cases with HIV and controls without HIV did not differ significantly in days from onset to presentation (average 2.8 and 3.2), temperature (average 37.9 C and 37.7 C), or percent with a delayed H1N1 diagnosis (7% and 13%).
A significantly higher proportion of people without HIV had pneumonia (25% versus 9%, P = 0.0105) or respiratory failure (21% versus 9%, P = 0.0362), although detection of concomitant bacteria did not differ significantly between the two groups (7% with HIV and 8% without HIV). Symptoms at H1N1 diagnosis did not differ significantly between cases and controls, except that people with HIV had a higher rate of gastrointestinal complaints (38% versus 19%, P = 0.0035).
Several average lab values distinguished H1N1 patients with HIV from those without HIV:
· Total lymphocytes: 1511 +/- 719 with HIV, 1033 +/- 466 without HIV, P = 0.0001
· C-reactive protein (mg/dL): 3.4 +/- 3.5 with HIV, 5.3 +/- 5.9 without HIV, P = 0.0283
· Lactate dehydrogenase (U/L): 337 +/- 109 with HIV, 537 +/- 370 without HIV, P = 0.0364
· Platelets: 174,768 +/- 61,694 with HIV, 194,207 +/- 71,274 without HIV, P = 0.0691
· Leukocytes: 6367 +/- 2341 with HIV, 7602 +/- 5145 without HIV, P = 0.0839
Levels of creatinine and aspartate aminotransferase did not differ significantly between the two groups.
Among people with HIV, 9% had a CD4 count below 200 at H1N1 diagnosis, 30% had a count between 200 and 500, and everyone else had more than 500 CD4s. Fifty-three people with HIV and H1N1 (95%) had an HIV load below 50 copies. Median CD4 count stood at 583 at H1N1 diagnosis and 466 after 4 to 6 weeks, a nonsignificant difference. Median viral load was 50 copies both at H1N1 diagnosis and 4 to 6 weeks later.
A higher proportion of H1N1 patients without HIV spent more than 1 day in the hospital (42% versus 27%, P = 0.0469), and a lower proportion without HIV recovered within 1 week (56% versus 77%, P = 0.0056). These differences may partly reflect more frequent use of oseltamivir (Tamiflu) to treat H1N1 in the HIV group (95% versus 71%, P = 0.0003). Three people in the HIV-negative group (2%) and no one in the HIV group died.
Reference
1. Martinez E, Marcos M, Hoyo I, et al. 2009 H1N1 virus infection in HIV+ adults
17th Conference on Retroviruses and Opportunistic Infections. February 16-19, 2010. San Francisco. Abstract 802LB.
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