Abstract
Objective
To describe the clinical aspects of H1N1 among HIV coinfected patients seen at a reference center for AIDS treatment in São Paulo, Brazil.
Design
Observational and prospective cohort study.
Methods
Descriptive study of clinical and laboratory investigation of HIV-infected patients with confirmed diagnosis of influenza A (H1N1) in 2009. We analyzed patients monitored in CRT/DST/AIDS, a specialized service for people living with HIV, located in São Paulo, Brazil.
Results
108 individuals presented with symptoms of H1N1 infection at the CRT DST/AIDS in 2009. Eighteen patients (16.7%) had confirmation of the diagnosis of influenza A. Among the confirmed cases, ten (55.6%) were hospitalized and eight (44.4%) were outpatients. Dyspnea was present in nine patients (50%), hemoptysis in three (16%). Six patients (60%) required therapy with supplemental oxygen. All patients had good clinical outcomes and none died.
Conclusions
In our hospital, the symptoms that led patients to seek medical care were similar to the common flu. Hospital admission and the early introduction of antibiotics associated with oseltamivir may have been the cause of the favorable outcome of our cases.
Keywords: influenza A virus, H1N1 subtype; HIV; acquired immunodeficiency syndrome
References
- 1.Writing Committee of the WHO Consultation on Clinical Aspects of Pandemic (H1N1) 2009 Influenza Clinical aspects of pandemic 2009 influenza A (H1N1) virus infection. N Engl J Med. 2010;362:17081719. doi: 10.1056/NEJMra1000449. [DOI] [PubMed] [Google Scholar]
- 2.Centro de Vigilância Epidemiológica “Prof. Alexandre Vranjac” Coordenadoria de Controle de Doenças. Secretaria de Estado da Saúde. São Paulo, SP, Brasil Informe epidemiológico influenza pandêmica H1N1 2009 – Abril, 2010. Bepa Abril. 2010;7(76) [Google Scholar]
- 3.Freitas G.D., Carvalhanas T.R.M.P., Liphaus B.L. Influenza A/H1N1: cenário atual e novos desafios. BEPA, Bol. epidemiol. paul. 2009;6(67):2430. (Online) [online] [Google Scholar]
- 4.Jain S., Kamimoto L., Bramley A.M. Hospitalized Patients with 2009 H1N1 Influenza in the United States, April June 2009. N Engl J Med. 2009;361:193544. doi: 10.1056/NEJMoa0906695. [DOI] [PubMed] [Google Scholar]
- 5.Clinical management of human infection with pandemic (H1N1) 2009: revised guidance. Geneva: World Health Organization, November 2009.
- 6.Updated Interim Recommendations — HIV Infected Adults and Adolescents: Considerations for Clinicians Regarding 2009 H1N1 Influenza. Atlanta: Centers for Disease Control and Prevention, October, 21, 2009. www.cdc.gov/h1n1flu/guidance_hiv.htm.
- 7.Del Rio C. New CDC Interim Guidance on HIV and H1N1. Journal Watch HIV/AIDS Clinical Care. 2009 November 2. [PubMed] [Google Scholar]
- 8.Aviram G., Bar-Shai A., Sosna J. H1N1 influenza: initial chest radiographic findings in helping predict patient outcome. Radiology. 2010;255(1):2529. doi: 10.1148/radiol.10092240. [DOI] [PubMed] [Google Scholar]
- 9.Morbidity and Mortality Weekly Report www.cdc.gov/mmwr. Bacterial Coinfections in Lung Tissue Specimens from Fatal Cases of 2009. Pandemic Influenza A (H1N1) — United States, May – August 2009. 2009; 58 (Early Release):14. [PubMed]
- 10.Teran G.R., de la Rosa Zamboni D., Vázquez Pérez Y. Program and abstracts: 17a Conferences on Retroviruses and Opportunistic Infections. CROI; São Francisco: 2010. Clinical Features of Subjects Infected with HIV and H1N1 Influenza Vírus. Inst Natl de Enfermedades Respiratorias, Mexico City, Mexico. [Google Scholar]
- 11.Zarychanski R, Stuart TL, Kumar A, et al. Correlates of severe disease in patients with 2009 pandemic influenza (H1N1) virus infection. Early release, published at www.cmaj.ca on January 21, 2010. Subject to revision. [DOI] [PMC free article] [PubMed]
- 12.McGeer A., Green K.A., Plevneshi A. Antiviral therapy and outcomes of influenza requiring hospitalization in Ontario. Canada. Clin Infect Dis. 2007;45:156875. doi: 10.1086/523584. [DOI] [PubMed] [Google Scholar]
- 13.Lee N., Cockram C.S., Chan P.K. Antiviral treatment for patients hospitalized with severe influenza infection may affect clinical outcomes. Clin Infect Dis. 2008;46:13234. doi: 10.1086/533477. [DOI] [PubMed] [Google Scholar]