|
Indian Pediatr 2011;48: 131-132 |
|
Clinical Profile of H1N1 Positive HIV-
Infected Children |
Rajesh Kulkarni, Aarti Kinikar and Chhaya Valvi
From the Department of Pediatrics, BJ Medical College,
Pune, Maharashtra, India.
Correspondence to: Dr Rajesh Kulkarni, Assistant
Professor (Pediatrics), BJ Medical College, Pune, India.
Email: [email protected]
Received: March 29, 2010;
Initial review: April 5, 2010;
Accepted: April 23, 2010.
Published online: 2010 August 1.
PII: S097475591000256-2
|
Abstract
We report five cases of HIV infected children, who
presented with flu-like symptoms and were diagnosed to have H1N1
infection (swine origin influenza). Four of these children were admitted
with respiratory distress and pneumonia and were managed in swine flu
isolation ICU. Two children required nonivasive ventilatory support. All
children recovered completely and at discharge were referred for
initiation of ART.
Key words: HIV, H1N1, Influenza.
|
T o the best of our knowledge, there
is no published data on HIV infected children with severe H1N1 infection
(swine origin influenza 2009) [1-3]. There is no documented information on
clinical interactions between HIV and influenza A (H1N1) virus. There is
insufficient information on complications and spectrum of illness,
although complications are likely to be similar to those of seasonal
influenza. In previous seasonal influenza outbreaks, HIV-infected persons
had more severe infections and increased hospitalization and mortality
rates [4]. The symptoms might be prolonged and the risk of
influenza-related complications higher for certain HIV infected people. We
report five children managed at our centre who were HIV positive, not on
ART, with H1N1 infection.
Methods
Children who had influenza like illness (ILI) were
admitted to an isolation ward or ICU depending on their clinical
condition. HIV infection was suspected in those children who had failure
to thrive, history of recurrent infections or those whose parents reported
high risk behavior. Four children were diagnosed seropositive after
admission for suspected H1N1. Three consecutive ELISA tests were used to
diagnose HIV infection in children older than 18 months. In case of the 4
month old child, HIV DNA PCR was used to confirm HIV infection. H1N1
infection was confirmed by RT-PCR.
Results
The age of children who were HIV and H1N1 positive
ranged from 2 to 10 years. Severe hypoxemia was seen in two children which
responded well to bubble CPAP. Chest X-ray showed unilateral or
bilateral parahilar infiltrates, similar to those seen in children who
were HIV negative but H1N1 positive. CD 4 counts and CD percentage (for
children >5 and <5 years, respectively). in children who were HIV and H1N1
positive were in the range for which initiation of ART is recommended.
Blood cultures were sterile in all children. All five children were
discharged home on anti-retroviral therapy. Details are shown in
Table I.
TABLE I
Clinical and Laboratory Features, and Outcome of HIV Positive Children with H1N1
Characteristic |
Case 1 |
Case 2 |
Case 3 |
Case 4 |
Case 5 |
Age/sex |
10 y/F |
3 y/M |
4 mo/M |
7 y/F |
2 y/M |
CD4 count |
253 |
112 |
|
270 |
|
Symptom duration (d) |
Fever |
10 |
4 |
3 |
5 |
8 |
Cough |
10 |
4 |
8 |
5 |
8 |
Resp. distress |
5 |
1 |
3 |
5 |
— |
Parotid swelling |
— |
— |
— |
— |
3 |
SPO2 (air) |
96% |
86%, 97%* |
84%, 96%* |
96% |
97% |
ABG |
Normal |
Normal* |
Normal* |
Normal |
Normal |
Treatment given (d) |
Bubble CPAP |
— |
3 |
4 |
— |
— |
O2 |
3 |
5 |
2 |
2 |
— |
Oseltamivir |
10 |
5 |
5 |
5 |
5 |
Antibiotics |
10 |
10 |
7 |
7 |
5 |
Cotrimoxazole |
14 |
14 |
14 |
14 |
14 |
SPO2: Oxygen saturation by pulse oximetry, ABG: Arterial blood gas, ART: Anti- retroviral therapy; *bubble CPAP.
|
Discussion
The presentation of children who had HIV infection and
tested positive for HIV was similar to those who were HIV negative i.e.
cough, cold and fever followed by respiratory distress (Unpublished data).
Only one child presented with respiratory symptoms and parotid enlargement
which could be attributed to either HIV infection itself or to H1N1
infection.
Children who were HIV positive with H1N1 were treated
in the same way as the HIV negative, H1N1 positive patients (i.e.
oseltamivir, broad spectrum antibiotics, bubble CPAP and oxygen). The mean
hospital stay was also similar in these two groups i.e. 7 days
(Unpublished data). All children tolerated oseltamivir well with no
adverse effects. All patients were empirically given intra-venous
antibiotics and oral cotrimoxazole in view of the likely immunosuppressed
status and possibility of serious bacterial and P. jarivi
infection.
High index of suspicion and early treatment can reduce
the rate of complications and mortality in these patients. HIV-infected
persons should be considered as a high risk and a priority population for
preventive and therapeutic strategies against influenza including emerging
influenza A (H1N1) virus infection.
Persons with HIV infection should be considered for
post-exposure prophylaxis with oseltamivir, prophylaxis being continued
for 10 days after the last known exposure to an suspected or confirmed
case [5]. Post-exposure prophylaxis is recommended for HIV-infected
persons who are household contacts of individuals with influenza A (H1N1).
Contributors: RK and CV collected patients’
records, performed data analysis and drafted the manuscript. AK and RK
contributed to data acquisition and performed the review of the
literature. All authors approved the final manuscript.
Funding: None. Competing interests:
None stated.
References
1. Centers for Disease Control and Prevention. Use of
rapid influenza diagnostic tests for patients with influenza-like illness
during the novel H1N1 influenza virus (swine flu) outbreak [cited 2009 Oct
8]. Available from www.cdc.gov/h1n1flu/ guid ance/rapid_testing.htm.
Accessed April 9, 2010.
2. Cunha BA. Pneumonia Essentials, 3rd ed. Sudbury
(MA): Jones and Bartlett; 2010.
3. Cunha BA. The clinical diagnosis of severe viral
influenza A. Infection. 2008;36:92-3.
4. Radwan HM, Cheeseman SH, Lai KK, Ellison III RT.
Influenza in human immunodeficiency virus-infected patients during the
1997-1998 influenza season. Clin Infect Dis.2000;31:604-6.
5. Pan American Health Organization.Considerations on
Influenza A (H1N1) and HIV infection. Available from: www.paho.org/influenzaah1n1/-.
Accesssed April 9, 2010
|
|
|
|