Clinical Presentation of 2009 H1N1 Influenza A Disease in HIV-Infected Patients

Abstract

Background: H1N1-novel Influenza A seemed to take the United States by surprise in the summer of 2009, and it soon reached epidemic proportions, affecting large and varied sections of the population. Immune-compromised patient populations, including human immunodeficiency virus (HIV)-infected individuals, were thought to be at higher risk. The study examined the severity and characteristics of H1N1 Influenza disease in HIV-infected patients and assessed treatment outcomes. Methods: Retrospective chart review of 2951 HIV-infected patients from May 1, 2009 to December 31, 2009. Results: Ninety-four patients presented with flulike symptoms, and 25 patients tested positive by culture for H1N1. Only 4 of 25 rapid test results were positive. The mean age was 46 years. Ninety-two percent were on antiretroviral therapy, and 56% were men. The mean CD4+ T-cell count was 496/μL, and viral load was undetectable in 60% of the patients. Ten patients required hospitalization, and 3 received mechanical ventilation. One patient died. Twenty-four patients received osetalmivir, and one patient recovered without treatment. There was no difference between the hospitalized and nonhospitalized patients in the CD4+ T-cell count (P = 0.8462) and viral load (P = 0.5849). Hospitalized patients were older (mean age, 54.3 vs. 41.5 years, P = 0.001), and logistic regression analysis showed that age older than 46 years (OR = 18.000; 95% confidence interval, 1.75-184.68, P = 0.032) was associated with hospitalization. Conclusions: H1N1 influenza was a rare occurrence in our population. Most of the patients recovered. Older patients were more likely to get hospitalized.