New CDC Interim Guidance on HIV and H1N1

11:18 04.11.2009

     HIV-infected individuals are a high priority group for prevention and treatment of 09 H1N1 influenza.  It has become clear that individuals with immune suppression are at increased risk for severe disease complications, and premature death related to H1N1.  The key recommendations are as follows

     *early treatment with oseltamir or zanavir (Tamiflu) should be considered for HIV-infected adults and adolescents who have suspected or confirmed influenza

      *  Antiviral chemoprophylaxis should be considered for HIV infected adults and adolescents who have had close contct with someone-likely to have been infected in influenza virus

     *HIV-infected adults and adolescents should receive the injectable inactivated form of both H1N1 vaccine and the seasonal influenza vaccine.

      *HIV-infected patents should avoid use of intranasal influenza vaccines, which contain live attenuated virus and are the ones most available at this time.  Currently there are 3 inactivated live attenuated virus vaccines . 

      There are a couple of problems with these recommendation.  First the test for H1N1 is not very reliable.  Second, H1N1 infections in this authors mind has been blown out of proportion to seasonal influenzas.  Third the seasonal vaccine offers some protection against H1N1 and definitely should be given not only to all HIV patients but to all people. 40,000 people did of seasonal influenza each year, and the number of H1N1 deaths this year wilt nowhere come close to that number. Fifth, H1N1 is not a very serious condition in most people including HIV people, and the ability of H1N1 to mutate leaves questions about have a mutated attenuated live virus in ones system.