TY - JOUR
T1 - Impact of Human Immunodeficiency Virus on the Burden and Severity of Influenza Illness in Malawian Adults
T2 - A Prospective Cohort and Parallel Case-Control Study
AU - Ho, Antonia
AU - Aston, Stephen J.
AU - Jary, Hannah
AU - Mitchell, Tamara
AU - Alaerts, Maaike
AU - Menyere, Mavis
AU - Mallewa, Jane
AU - Nyirenda, Mulinda
AU - Everett, Dean
AU - Heyderman, Robert S.
AU - French, Neil
N1 - Funding Information:
Financial support. This work was supported by the Wellcome Trust (grant 097464/Z/11/A).
Funding Information:
Potential conflicts of interest. N. F. has received grant support from GlaxoSmithKine outside the submitted work. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
Publisher Copyright:
© 2017 The Author(s).
PY - 2018/3/5
Y1 - 2018/3/5
N2 - Background. Te impact of human immunodefciency virus (HIV) infection on influenza incidence and severity in adults in sub-Saharan Africa is unclear. Seasonal influenza vaccination is recommended for HIV-infected persons in developed settings but is rarely implemented in Africa. Methods. We conducted a prospective cohort study to compare the incidence of laboratory-confrmed influenza illness between HIV-infected and HIV-uninfected adults in Blantyre, Malawi. In a parallel case-control study, we explored risk factors for severe influenza presentation of severe (hospitalized) lower respiratory tract infection, and mild influenza (influenza-like illness [ILI]). Results. Te cohort study enrolled 608 adults, of whom 360 (59%) were HIV infected. Between April 2013 and March 2015, 24 of 229 ILI episodes (10.5%) in HIV-infected and 5 of 119 (4.2%) in HIV-uninfected adults were positive for influenza by means of polymerase chain reaction (incidence rate, 46.0 vs 14.5 per 1000 person-years; incidence rate ratio, 2.75; 95% confdence interval, 1.02-7.44; P =.03; adjusted for age, sex, household crowding, and food security). In the case-control study, influenza was identifed in 56 of 518 patients (10.8%) with hospitalized lower respiratory tract infection, and 88 or 642 (13.7%) with ILI. Te HIV prevalence was 69.6% and 29.6%, respectively, among influenza-positive case patients and controls. HIV was a signifcant risk factor for severe influenza (odds ratio, 4.98; 95% confdence interval, 2.09-11.88; P <.001; population-attributable fraction, 57%; adjusted for season, sanitation facility, and food security). Conclusions. HIV is an important risk factor for influenza-associated ILI and severe presentation in this high-HIV prevalence African setting. Targeted influenza vaccination of HIV-infected African adults should be reevaluated, and the optimal mechanism for vaccine introduction in overstretched health systems needs to be determined.
AB - Background. Te impact of human immunodefciency virus (HIV) infection on influenza incidence and severity in adults in sub-Saharan Africa is unclear. Seasonal influenza vaccination is recommended for HIV-infected persons in developed settings but is rarely implemented in Africa. Methods. We conducted a prospective cohort study to compare the incidence of laboratory-confrmed influenza illness between HIV-infected and HIV-uninfected adults in Blantyre, Malawi. In a parallel case-control study, we explored risk factors for severe influenza presentation of severe (hospitalized) lower respiratory tract infection, and mild influenza (influenza-like illness [ILI]). Results. Te cohort study enrolled 608 adults, of whom 360 (59%) were HIV infected. Between April 2013 and March 2015, 24 of 229 ILI episodes (10.5%) in HIV-infected and 5 of 119 (4.2%) in HIV-uninfected adults were positive for influenza by means of polymerase chain reaction (incidence rate, 46.0 vs 14.5 per 1000 person-years; incidence rate ratio, 2.75; 95% confdence interval, 1.02-7.44; P =.03; adjusted for age, sex, household crowding, and food security). In the case-control study, influenza was identifed in 56 of 518 patients (10.8%) with hospitalized lower respiratory tract infection, and 88 or 642 (13.7%) with ILI. Te HIV prevalence was 69.6% and 29.6%, respectively, among influenza-positive case patients and controls. HIV was a signifcant risk factor for severe influenza (odds ratio, 4.98; 95% confdence interval, 2.09-11.88; P <.001; population-attributable fraction, 57%; adjusted for season, sanitation facility, and food security). Conclusions. HIV is an important risk factor for influenza-associated ILI and severe presentation in this high-HIV prevalence African setting. Targeted influenza vaccination of HIV-infected African adults should be reevaluated, and the optimal mechanism for vaccine introduction in overstretched health systems needs to be determined.
KW - HIV
KW - influenza
KW - Malawi
UR - https://www.scopus.com/pages/publications/85043461678
U2 - 10.1093/cid/cix903
DO - 10.1093/cid/cix903
M3 - Article
C2 - 29045699
AN - SCOPUS:85043461678
SN - 1058-4838
VL - 66
SP - 865
EP - 876
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 6
ER -
