In the Journals Plus

Low CD4 count in patients with HIV prolongs influenza viral shedding

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June 5, 2018

HIV-infected individuals with a low CD4 count experienced a longer duration of influenza virus shedding, according to findings published in The Journal of Infectious Diseases.

“Prolonged shedding of influenza viruses may be associated with increased transmissibility and resistance mutation acquisition due to therapy,” Claire von Mollendorf, MD, a lecturer for the School of Public Health at the University of Witwatersrand in Johannesburg, South Africa, and colleagues wrote in the study.

Researchers conducted a prospective cohort study spanning three consecutive influenza seasons from 2012 to 2014 and enrolled 264 HIV-infected and HIV-uninfected patients who had a laboratory-confirmed influenza diagnosis. According to the study, enrollment was limited to patients aged older than 6 months who presented to an outpatient clinic within 72 hours of symptom onset.

Influenza diagnosis was confirmed by PCR, the researchers said.

Of the 264 study participants, 65 were HIV-infected and 176 were HIV-uninfected.

von Mollendorf and colleagues observed no significant difference regarding influenza virus shedding duration between HIV-infected individuals (median days = 6, interquartile range [IQR] 3-10) and HIV-uninfected individuals (median days = 7, IQR 4-11).

However, after adjusting their analysis for age, the researchers found that HIV-infected individuals with low CD4 counts shed influenza virus for a longer duration compared with HIV-infected patients with higher counts (adjusted HR = 3.55; 95% CI, 1.05-12.08).

Based on these results, von Mollendorf and colleagues recommended that HIV-infected patients be prioritized for annual influenza vaccination.

“It is important to understand transmission dynamics to prevent transmission to these groups as the effectiveness of influenza vaccine in severely immunocompromised individuals has not been established and prolonged antiviral use may lead to the development of resistant mutants,” they wrote. – by Marley Ghizzone

Disclosures: von Mollendorf reports an institutional grant from the CDC. Please see the study for all other authors’ relevant financial disclosures.