In April, the United States began to feel the brunt of an alarming new flu, caused by the H1N1 virus. Commonly called swine flu, novel H1N1 has now caused illness in nearly 40,000 people, along with 9,079 hospitalizations and 593 deaths. And although the initial crest of illness has stabilized, many still fear how this virus might impact the general public during the coming flu season. Having advocated for people living with HIV for 25 years, Project Inform is concerned about how this public health issue could affect people with HIV. We're committed to educating the community about how to prevent and treat H1N1.
Basic information
Although H1N1 viruses are common flu bugs, this 2009 strain has been more noteworthy given its unique mix of genes. Anyone can contract H1N1, but those at higher risk for more severe disease include pregnant women and people with weakened immune systems, lung conditions, heart or kidney disease, diabetes, or other underlying condition. HIV-positive people with lower CD4s (200 or less) or other infections such as TB are also at higher risk. People 25 years and younger seem to have a higher rate of disease from this flu strain.
Recognize the symptoms
Common H1N1 symptoms are typical flu symptoms: fever, cough, fatigue, aches, runny or stuffy nose, sore throat, and some trouble breathing. Some people report more nausea and vomiting. Emergency warning signs include more difficult breathing, sudden dizziness, confusion, chest pain or pressure, severe or continued vomiting, or symptoms that persist or get worse. Contact your doctor as soon as you notice unusual or persistent symptoms.
Treat the symptoms
Two flu medicines, inhaled Relenza (zanamivir) and oral Tamiflu (oseltamivir), are effective against H1N1 and other flu viruses. Both seem to be as effective when used by HIV-positive people and appear safe to take with HIV meds. Two other medicines, Flumadine (rimantadine) and Symmetrel (amantadine), are not effective for treating H1N1, though they work against other flu. Otherwise, taking ibuprofen to reduce fever, aches and pains, or using other over-the-counter medicines can help ease symptoms. The Centers for Disease Control and Prevention is currently looking at possible combination therapy should resistant H1N1 strains begin to appear.
Take precautions
Help prevent the spread of H1N1 and other flu by following these simple rules: wash your hands often with soap and water, especially after coughing or sneezing; cough or sneeze into your elbow or a tissue; avoid touching your eyes, nose or mouth; use alcohol-based cleaners for hands or common public surfaces; avoid crowds of people or those who seem to be sick; stay home or limit contact with others when you feel symptoms; and stay home at least 24 hours after fever has finally resolved.
Guidance for people with HIV
Healthy HIV-positive people probably are not at higher risk for getting the flu. However, those with weaker immune systems or with AIDS can experience more severe disease from seasonal flu, as well as H1N1. For some, symptoms may arrive more rapidly and other infections may also occur. lang=EN As a preventive measure, it's wise for those living with HIV and in close contact with people having probable or confirmed cases of H1N1 to consult their doctors if they should take flu medicine before they get sick.
Having adequate supplies of HIV meds, food, and personal support is one way to hold you over from a possible bout of the flu. Given the California budget crisis, the AIDS Drug Assistance Program will likely not cover flu medicines. You may want to consult your doctor about getting other vaccines such as the pneumococcal vaccine to prevent Streptococcal pneumonia.
The H1N1 vaccine
The probable two-shot H1N1 vaccine is expected to be available in the fall, although specific dates aren't known. However, it will not protect against other common flu viruses. Likewise, the seasonal flu vaccine will not protect against H1N1. Both can probably be given at the same time. However, getting the seasonal vaccine now could be less burdensome for you as well as health care facilities.
A limited supply of H1N1 vaccine will be available at first, and certain populations will be prioritized. These include pregnant women, people who live with or care for children 6 months of age or younger, health care workers, persons between 6 months and 24 years old, and people aged 25 to 64 years who are at higher risk because of weaker immune systems, including HIV-positive people with more challenged health, such as low CD4s. State and local health departments are working diligently on distribution plans.
The take home message
Most people who have become sick from H1N1 recover without medical treatment, and others recover quickly with prompt attention for their illness. For people living with HIV, the same precautions and treatment recommended for the general population appear to apply. However, having another condition, such as a lower CD4 count or lung disease, may make one more susceptible to H1N1 infection and more severe disease.
Despite all the media hoopla about H1N1, Project Inform discourages alarm about H1N1 but encourages everyone to prepare for the flu season. Get and stay informed about H1N1, avoid people who may be sick, be alert to symptoms, consult your doctor about the vaccine, and treat promptly – especially if severe symptoms occur. For more information, check out the following resources: http://www.projectinform.org/info/h1n1/index.shtml, http://www.sfcdcp.org/flu.html, and http://www.cdc.gov/h1n1flu. Or call the National HIV Treatment Hotline: 1-800-822-7422.
Alan McCord is director of information and outreach at Project Inform. This column is not intended as medical advice.