1690. Effects of HIV Status on Symptom Severity in Influenza Like Illness in a Healthy, Adult Outpatient Cohort
Session: Poster Abstract Session: HIV: Other Opportunistic Infections in HIV
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • 1690_IDWPOSTER.pdf (403.2 kB)
  • Background:

    The effects of HIV positivity on influenza like illness (ILI) are not well described in the HAART era.  Pre-HAART, most community viral infections were no more severe in HIV infected children.  More recent reports of patients with and without HIV hospitalized with influenza A pH1N1 revealed no differences in clinical severity.  There has not been a similar analysis of ILI severity in an HIV+ adult, otherwise healthy, predominantly outpatient cohort.

    Methods:

    The Acute Respiratory Infection Consortium (ARIC) is a multi-site network for the study of ILI at five military medical centers in the US.  Individuals presenting within 72 hours of ILI onset were prospectively enrolled in an observational cohort study. Patients with HIV, but no other significant comorbidities, were enrolled.  Viral etiologies were determined by nucleic acid amplification testing of nasopharyngeal specimens.  Demographics, clinical data and self-reported symptom severity were ascertained at baseline. Enrollees also completed a daily diary of symptom severity for 10 days.

    Results:

    957 adults were enrolled. Of these, 72 (7.5%) were HIV+.  HIV+ enrollees were more likely to be male, older, active duty and former smokers.  On multivariate analysis, HIV+ were more likely to be hospitalized (OR 2.72, 95% CI 1.02-7.21) and report use of antibiotics (OR 2.22, 95% CI 1.27-3.88).  Symptom severity was similar between groups; however HIV- enrollees reported higher upper respiratory composite scores (p=0.001) while HIV+ reported more diarrhea, muscle aches and fatigue.  HIV+ enrollees were more likely to have influenza B (p<0.001), otherwise detection of viral pathogens was similar.  Among HIV+ enrollees, CD4 counts significantly increased after resolution of ILI, with a mean at enrollment of 492 versus 612 at day 28 (p<0.001); however %CD4 was similar.  There was no significant change in HIV viral load.

    Conclusion:

    ILI severity was generally similar between HIV positive and negative enrollees, with HIV- reporting more upper respiratory symptoms and HIV+ more GI and systemic symptoms.  Despite this, HIV+ individuals were more likely to be hospitalized and to receive antibiotics, suggesting a possible bias for more cautious treatment of HIV+ patients.  With the exception of a slightly depressed CD4 count, HIV parameters were generally stable during ILI.

    Christina Schofield, MD FACP, FIDSA1, Mary Fairchok, MD2, Deepika Mor, MS3, Wei-Ju Chen, PhD3, Xun Wang, MS4, Xiuping Chu, MSCS, MSME5, Patrick Danaher, MD, FIDSA6, Tahaniyat Lalani, MD5, Michael Rajnik, MD7, Timothy Burgess, MD, MPH3, Michelande Ridore, MS5, John Arnold, MD8, Mary Bavaro, MD, FIDSA9, Brian Agan, MD, FIDSA10, Eugene Millar, PhD11 and Henry M. Jackson Foundation for the Advancement of Military Medicine, (1)Madigan Army Medical Center, Tacoma, WA, (2)Pediatrics, Mary Bridge Children's Hospital, Multicare, Tacoma, WA, (3)Infectious Disease Clinical Research Program, Uniformed Services University, Bethesda, MD, (4)The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, (5)Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, (6)San Antonio Military Health System, Fort Sam Houston, TX, (7)Walter Reed National Military Medical Center, Bethesda, MD, (8)Naval Medical Center San Diego, San Diego, CA, (9)Infectious Diseases, Naval Medical Center San Diego, San Diego, CA, (10)Infectious Disease Clinical Research Program, USUHS, Rockville, MD, (11)Infectious Disease Clinical Research Program, Rockville, MD

    Disclosures:

    C. Schofield, None

    M. Fairchok, None

    D. Mor, None

    W. J. Chen, None

    X. Wang, None

    X. Chu, None

    P. Danaher, None

    T. Lalani, None

    M. Rajnik, None

    T. Burgess, None

    M. Ridore, None

    J. Arnold, None

    M. Bavaro, None

    B. Agan, None

    E. Millar, None

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