Swine flu: AIDS patients not at greater risk of infection

Published in The Hindu on August 13, 2009

The immune system of people with HIV/AIDS is compromised.Yet, they are not considered to be at a greater risk of getting infected with swine flu compared with the general population.

“HIV infected people are not at a greater risk of getting infected with swine flu compared to the general population,”said Dr. R. Paranjape, Director of the National AIDS Research Institute, Pune.

According to the U.K. National Health Services (NHS),the risk of catching swine flu by a person who is HIV positive is probably not high. “Although HIV infects CD4 cells and reduces their number and function, there are other parts of the immune system that are able to fight the flu,”it states.

Dr. Joel Gallant, Professor of Medicine and Epidemiology in the Division of Infectious Diseases at the Johns Hopkins University School of Medicine explains in the body.com the reason why people with HIV/AIDS are not particularly at risk of getting infected.

Not more susceptible

“HIV-infected people are not in general at greater risk of influenza or flu than other people. And that’s in part because the cellular immune system, the part of the immune system that the CD4cells comprise, is not really responsible for fighting the flu.

As a result, HIV doesn’t make you more susceptible.For most people with HIV,the swine flu is pretty much the same as it would be with somebody without HIV,” Dr.Gallant was quoted as saying in the body.com.

Sujatha Rao, Director General of the National AIDS Control Organisation (NACO), Delhi, shares Dr. Paranjape’s views. “There are no special precautions that people with HIV/AIDS need take to prevent swine flu infection,”she said.

In fact, an advisory sent by the NACO to all centres that provide antiretroviral therapy (ART) does not talk of any special precautions that people with HIV/AIDS should take to prevent swine flu infection.

The advisory only mentions that people with any of the common symptoms of swine flu – cough, fever, sore throat,running nose, body ache,chills or fatigue – should we ara mask before entering the centre.

The ART centres in turn should provide masks at the entrance of the centres to such people who are not wearing it. The ART centres are also required to examine these patients on a first priority basis.

But HIV positive people who are infected with swine flu are at a greater risk of suffering from complications.

Severe complications

“If you have a low CD4 count (under 200), you maybe more likely to suffer complications like pneumonia from any type of flu, including swine flu,” notes the NHS.

“But how those [HIV positive people] infected with swine flu would suffer is not known as the swine flu virus is new and we don’t have enough data,” said Dr. Paranjape.

It would probably be correct to assume that many people with no underlying disease and with good immune system will be able to fight the infection even without any medication.

HIV positive people with their immune system compromised may therefore suffer from greater complications from swine flu.

According to the Centres for Disease Control (CDC), Atlanta, United States, HIV positive people, and especially those with low CD4 cell counts are known to be at higher risk for viral and bacterial lower respiratory tract infections and for recurrent pneumonias.

“It is possible that HIV-infected adults and adolescents are also at higher risk for novel influenza A(H1N1) virus infection complications,” the CDC states.

The CDC notes that “Evidence that influenza can be more severe for HIV-infected adults and adolescents comes from studies among HIV-infected persons who had seasonal influenza; these data are limited.”

According to the CDC, people with HIV/AIDS and especially persons with low CD4 cell counts or AIDS can experience more severe complications of seasonal influenza.

And it is possible that HIV infected adults and adolescents are also at higher risk for novel influenza A (H1N1) virus infection complications.