Influenza A among Patients with Human Immunodeficiency Virus: An Outbreak of Infection at a Residential Facility in New York City

Abstract

Although annual influenza vaccination is recommended for persons who are infected with human immunodeficiency virus (HIV), data are limited regarding the epidemiology of influenza or the effectiveness of influenza vaccination in this population. We investigated a 1996 outbreak of infection with influenza A at a residential facility for persons with AIDS. We interviewed 118 residents and employees, reviewed 65 resident medical records, and collected serum samples for measurement of influenza antibody titers. After controlling for history of smoking, influenza vaccination, and resident or employee status, in a multivariate model, HIV infection was not statistically associated with influenza-like illness (ILI). Symptoms and duration of ILI were similar for most HIV-infected and HIV-uninfected persons. However, 8 (21.1%) of 38 HIV-infected persons with ILI (vs. none of 15 HIV-uninfected persons) were either hospitalized, evaluated in an emergency room, or had ILI lasting > or = 14 days (P=.06). Vaccination effectiveness (VE) was similar for HIV-infected and HIV-uninfected persons. Vaccination was most effective among HIV-infected persons with CD4 cell counts of >100 cells/microL (VE, 65%; 95% CI, 36%--81%) or HIV type 1 virus load of <30,000 copies/mL (VE, 52%; 95% CI, 11%--75%). Providers should continue to offer influenza vaccination to HIV-infected persons.

2012/13 influenza vaccine effectiveness against hospitalised influenza A(H1N1)pdm09, A(H3N2) and B: estimates from a European network of hospitals

“…TIV is immunogenic among HIV-infected persons with normal CD4 counts. [261][262][263][264] However, data show TIV to be less immunogenic, with a possible reduced vaccine efficacy, in persons with low CD4 counts. [262,265,266] Further, a second dose does not improve immune responses in this group.…”

“…[261][262][263][264] However, data show TIV to be less immunogenic, with a possible reduced vaccine efficacy, in persons with low CD4 counts. [262,265,266] Further, a second dose does not improve immune responses in this group. [265] Studies on the performance of monovalent inactivated influenza A(H1N1)pdm vaccine have similar findings with reduced immunogenicity (60%) among HIVpositive individuals, particularly those with lower CD4 counts.…”

Shedding of live vaccine virus, comparative safety, and influenza-specific antibody responses after administration of live attenuated and inactivated trivalent influenza vaccines to HIV-infected children

“…The immunogenicity of TIV in HIV-infected adults and children with advanced disease is limited, whereas it is more likely to induce a strong response in those in earlier phases of HIV infection (15)(16)(17)(18). Although the efficacy of TIV in HIV-infected children has not been established, there is some evidence of its efficacy in HIV-infected adults (9,19).…”

Immunization of HIV-infected adult patients — French recommendations

“…40,41 Data from the pre-cARTera indicated elevated hospitalization rates and substantial excess mortality due to pneumonia or influenza during influenza seasons. 42,43 Dramatic declines in hospitalization and mortality rates were observed with the introduction of cART with hospitalization rates comparable to rates in other high-risk groups but mortality rates that remain greater than in the general population.…”