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New CDC Interim Guidance on HIV and H1N1

HIV-infected individuals are a high-priority group for prevention and treatment of 2009 H1N1 influenza.

As the 2009 H1N1 influenza pandemic has evolved, it has become clear that individuals with immune suppression are at increased risk for severe disease, complications, and premature death related to H1N1. To that end, the CDC has updated its interim guidance on the prevention and management of 2009 H1N1 influenza in HIV-infected individuals. Key recommendations are as follows:

• Early treatment with oseltamivir or zanamivir should be considered for HIV-infected adults and adolescents who have suspected or confirmed influenza.
  
• Antiviral chemoprophylaxis should be considered for HIV-infected adults and adolescents who have had close contact with someone likely to have been infected with influenza virus.
  
• HIV-infected adults and adolescents should receive the injectable inactivated forms of both the H1N1 vaccine and the seasonal influenza vaccine.
  

Comment: Although some controversy exists around whether HIV infection influences the presentation and outcomes of seasonal influenza, the recommendation to aggressively treat 2009 H1N1 influenza in those with HIV infection seems wise, as does the recommendation to vaccinate against both seasonal influenza and 2009 H1N1 influenza. HIV-infected patients should avoid use of intranasal influenza vaccines, which contain live attenuated virus and are the ones most readily available at this time. Currently, there are three inactivated vaccines available to protect against 2009 H1N1 influenza; they are produced by Sanofi Pasteur, Novartis, and CSL Limited. The live attenuated vaccine is produced by MedImmune. None of the influenza vaccines currently available in the U.S. (seasonal or H1N1) contains adjuvants. A complete list of the approved 2009 H1N1 influenza vaccines, with details on recommended dosing, can be found in the October 8, 2009, edition of MMWR Weekly.

— Carlos del Rio, MD

Published in Journal Watch HIV/AIDS Clinical Care November 2, 2009

Citation(s):

Centers for Disease Control and Prevention (CDC). Updated interim recommendations — HIV-infected adults and adolescents: Considerations for clinicians regarding 2009 H1N1 influenza. Oct 21 , 2009. (http://www.cdc.gov/h1n1flu/guidance_HIV.htm)

Reader Remarks:

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• Additions to the High Priority Group
  Kelly M Butler, 3 Nov 2009 12:55 PM EST
  Gratified that HIV infected persons have been added to the high priority group.
  
  One group that has been missed and... [more]