Influenza in Patients with Human Immunodeficiency Virus Infection: Discussion (Part 2)

In: Influenza

24 Nov 2012

Although the prevalence of influenza in the 1988-1989 season, the virulence of predominant virus strains during this interval, and the lack of advanced immunosuppression in our cohort are variables that have not been controlled for, our findings agree with those findings of the scant published literature to date. No increased incidence or alteration in clinical presentation of influenza was noted in patients at risk for HIV infection in a New York City emergency room in 1988, and none of seven HIV-seropositive residents in a drug-treatment center developed symptoms during an influenza A (H1N1) outbreak compared with 14 (37 percent) of 38 seronegative individuals. flovent inhaler
The clinical features of influenza were not unique in this group of patients. However, the relatively poor oxygenation at the time of presentation (median P[A-a]02 = 49 mm Hg) is of concern. While we were not able to distinguish clinical differences in patients with influenza A (H1N1) infection from those with influenza B infection, most authorities agree that influenza B, the predominant strain in our series, tends to cause a relatively mild illness. Influenza A (H1N1) also has typically caused a benign illness since its reappearance in 1977, although an outbreak in elderly patients in 1978 was reported to be unusually serious in 1987. Despite the fact that the predominant influenza virus strains in the United States in the 1988-1989 season were influenza B and influenza A (H1N1), the proportion of deaths associated with pneumonia and influenza exceeded the epidemic threshold. Therefore, generalized statements about the expected severity of illness caused by these particular virus subtypes are not possible, and prospective comparison with a non-HIV-infected group of patients with influenza in a given year will be necessary to further assess severity of illness in patients with HIV infection.


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