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Influenzavirus infection is a primary cause of febrile respiratory illness in HIV-infected adults, despite vaccination.
Clin Infect Dis. 2007 Jul 15; 45(2):234-40.CI

Abstract

BACKGROUND

There are, to our knowledge, no prospective studies of respiratory tract infections in human immunodeficiency virus (HIV)-infected adults in the highly active antiretroviral therapy (HAART) era. We performed a surveillance study of outpatients who presented with fever and respiratory symptoms to examine the role of viral pathogens in these patients.

METHODS

Consecutive patients with a temperature of >38.0 degrees C and respiratory symptoms were recruited from a tertiary care HIV clinic during the period 2003-2006. Nasal pharyngeal samples were tested for influenzavirus A and B, respiratory syncytial virus, and human metapneumovirus using real-time multiplex polymerase chain reaction assays. Paired acute- and convalescent-phase serum samples were tested for respiratory viruses by complement fixation.

RESULTS

Fifty patients (90% of whom were receiving HAART) were included in the study (median CD4(+) T cell count, 325 cells/microL; median HIV RNA level, <50 copies/mL). A causative pathogen was identified in 25 patients (50%). Even though 76% of subjects had received influenza vaccine, viral infections were diagnosed in 21 patients (42%), as follows: influenza A, 10 patients; influenza B, 10; and parainfluenza virus type 3 infection, 1. Patients with and those without viral infection had similar demographic characteristics and HIV statuses. No patients with influenza and 23% of patients with other conditions had radiography-confirmed pneumonia (P=.07). Antibiotic prescriptions were common: 70% of patients received antibiotics. No patients with influenza required hospitalization, compared with 21% of other patients (P=.03).

CONCLUSIONS

Although illness was mild, influenza accounted for a large proportion of unscheduled visits to a health care provider for respiratory illness and was associated with unnecessary antibiotic prescriptions that may contribute to antimicrobial resistance. Vaccination alone was insufficient to prevent infection. Thus, specific identification and management of influenza should be performed in HIV-infected outpatients who present with fever and respiratory symptoms.

Authors+Show Affiliations

Department of Medicine, Division of Infectious Diseases, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada. marina.klein@muhc.mcgill.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17578785

Citation

Klein, Marina B., et al. "Influenzavirus Infection Is a Primary Cause of Febrile Respiratory Illness in HIV-infected Adults, Despite Vaccination." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 45, no. 2, 2007, pp. 234-40.
Klein MB, Lu Y, DelBalso L, et al. Influenzavirus infection is a primary cause of febrile respiratory illness in HIV-infected adults, despite vaccination. Clin Infect Dis. 2007;45(2):234-40.
Klein, M. B., Lu, Y., DelBalso, L., Coté, S., & Boivin, G. (2007). Influenzavirus infection is a primary cause of febrile respiratory illness in HIV-infected adults, despite vaccination. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 45(2), 234-40.
Klein MB, et al. Influenzavirus Infection Is a Primary Cause of Febrile Respiratory Illness in HIV-infected Adults, Despite Vaccination. Clin Infect Dis. 2007 Jul 15;45(2):234-40. PubMed PMID: 17578785.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Influenzavirus infection is a primary cause of febrile respiratory illness in HIV-infected adults, despite vaccination. AU - Klein,Marina B, AU - Lu,Ying, AU - DelBalso,Lina, AU - Coté,Stéphanie, AU - Boivin,Guy, Y1 - 2007/06/12/ PY - 2007/01/18/received PY - 2007/04/01/accepted PY - 2007/6/21/pubmed PY - 2007/7/10/medline PY - 2007/6/21/entrez SP - 234 EP - 40 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin. Infect. Dis. VL - 45 IS - 2 N2 - BACKGROUND: There are, to our knowledge, no prospective studies of respiratory tract infections in human immunodeficiency virus (HIV)-infected adults in the highly active antiretroviral therapy (HAART) era. We performed a surveillance study of outpatients who presented with fever and respiratory symptoms to examine the role of viral pathogens in these patients. METHODS: Consecutive patients with a temperature of >38.0 degrees C and respiratory symptoms were recruited from a tertiary care HIV clinic during the period 2003-2006. Nasal pharyngeal samples were tested for influenzavirus A and B, respiratory syncytial virus, and human metapneumovirus using real-time multiplex polymerase chain reaction assays. Paired acute- and convalescent-phase serum samples were tested for respiratory viruses by complement fixation. RESULTS: Fifty patients (90% of whom were receiving HAART) were included in the study (median CD4(+) T cell count, 325 cells/microL; median HIV RNA level, <50 copies/mL). A causative pathogen was identified in 25 patients (50%). Even though 76% of subjects had received influenza vaccine, viral infections were diagnosed in 21 patients (42%), as follows: influenza A, 10 patients; influenza B, 10; and parainfluenza virus type 3 infection, 1. Patients with and those without viral infection had similar demographic characteristics and HIV statuses. No patients with influenza and 23% of patients with other conditions had radiography-confirmed pneumonia (P=.07). Antibiotic prescriptions were common: 70% of patients received antibiotics. No patients with influenza required hospitalization, compared with 21% of other patients (P=.03). CONCLUSIONS: Although illness was mild, influenza accounted for a large proportion of unscheduled visits to a health care provider for respiratory illness and was associated with unnecessary antibiotic prescriptions that may contribute to antimicrobial resistance. Vaccination alone was insufficient to prevent infection. Thus, specific identification and management of influenza should be performed in HIV-infected outpatients who present with fever and respiratory symptoms. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/17578785/Influenzavirus_infection_is_a_primary_cause_of_febrile_respiratory_illness_in_HIV_infected_adults_despite_vaccination_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1086/518986 DB - PRIME DP - Unbound Medicine ER -