Dear Dr. D,

My friend told me that since I am HIV positive, I am at greater risk for getting really sick from the H1N1 virus because my immunity is compromised. Is she correct or is this whole flu thing being blown way out of proportion in the media?

Micheal V.
Pretoria

Dear Michael,

I do understand what you are saying about the panic sometimes portrayed in the media, particularly when you consider that one thousand people die PER DAY in South Africa from HIV. Should we be acting with such hysteria when there have been three reported deaths thus far from the H1N1 (a.k.a. swine flu) virus?

Well, to be fair, one often has to err on the side of caution whenever it comes to a pandemic flu infection, particularly in the developing world where we are often ill-equipped to effectively address the containment of infectious disease.

That said, there’s also little point in falling prey to the hysteria fueled by media headlines. For those of us with HIV, all I can say at the moment is that, according to the Centers for Disease Control (CDC), there is nothing to suggest that people with HIV are at any greater risk for infection, acute illness, or death than the general population.

However, as HIV-positive adults and adolescents (especially those with low CD4 cell counts below 200) can often experience more severe complications of seasonal flu, it is possible that they would also be at greater risk for complications from the H1N1 strain.

HIV-positive individuals should do the same things as they would do for routine seasonal flu: contact your health care provider and allow him/her to determine if lab testing or treatment is needed. Symptoms of infection are more-or-less the same as for seasonal influenza. One can experience fever, cough, sore throat, runny or stuffy nose, headache, body aches, chills, and fatigue. Some with H1N1 have reported diarrhea and vomiting alongside the other symptoms.

Particularly if you are HIV-positive and have a low CD4 counts (or are HIV-positive adolescent), it’s worth getting treatment if you suspect you have flu of any variety. The antiviral Tamiflu® has been shown to effectively abate or diminish the symptoms of flu if taken with 48 hours of the first symptom. It is costly (around R500 for a five-day course), but you may find that being “penny-wise” is definitely “pound foolish” in this case, particularly if you have the financial resources.

As for antiretrovirals (ARVs), there is little data regarding the interaction between ARVs and anti-flu medication. To date, however, there have been no reports of any such interactions, and the only one who may be at risk from drugs like Tamiflu® are those with underlying kidney or neurological dysfunction.

To prevent the spread of the virus or to prevent getting it yourself, follow the standard seasonal guidelines:
1.Wash your hands often, using soap or an alcohol-based hand sanitiser.
2.Avoid touching your eyes, nose, or mouth with your hands.
3.Try to avoid close contact with anyone who is sick or exhibiting flu-like symptoms.
So I hope put your mind at ease. Swine flu probably doesn’t warrant the panic many have given it, but it does remind us how important it is to keep on top of our HIV care and treatment. And that means regularly monitoring your CD4 and viral load, and starting and adhering to your ARV therapy, if needed. By ensuring a healthy immune response, things like influenza will no more or less profound than they are to anyone else in the generally population.
So keep well and keep healthy,
Dr. D