Influenza in Patients with Human Immunodeficiency Virus Infection: Discussion (Part 4)

In: Influenza

26 Nov 2012

Only one patient in this series had evidence of a primary viral pneumonia (prevalence 16.7 percent; 95 percent confidence intervals, 0 to 46.5 percent). Studies in athymic mice suggest that the T-cell response may actually enhance parenchymal inflammation, so that deficient cellular immunity in HIV-infected hosts may in fact protect against early pulmonary abnormalities. A review of the English literature revealed only two reports of pneumonitis in HIV-infected patients with influenza, one a primary viral process and the other a secondary bacterial infection. In view of impaired neutrophil bactericidal activity and increased susceptibility to bacterial pneumonias in HIV-infected patients, it seems striking that no patient exhibited evidence of a secondary bacterial infection in this series. However, accurate comparison of the rate of pneumonitis in HIV-infected patients with that of previous estimates of 4.9 to 9.1 percent in patients with influenza is not possible with our current data. buy prednisone

In summary, we found that HIV-infected patients with influenza virus infection have a typical clinical presentation and a rate of secondary complications similar to those of normal subjects. Although possible trends toward more serious respiratory compromise and a prolonged duration of illness were- identified in this series, our small sample size allows only tentative conclusions. Prospective, controlled trials of larger numbers of patients using standardized clinical, virologic, and serologic measurements are needed to more accurately assess the response of HIV-infected patients to influenza infection.

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