Patel Pragna, Bush Timothy, Kojic E Milu, Overton Edgar T, Henry Keith, Önen Nur, Rhame Frank, Conley Lois, Brooks John T, Fry Alicia
1 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia .
2 Department of Infectious Diseases, Brown University , Providence, Rhode Island.
AIDS Res Hum Retroviruses. 2016 Dec;32(12):1180-1186. doi: 10.1089/AID.2015.0349. Epub 2016 Jun 13.
The duration of influenza virus shedding in HIV-infected adults is unknown and could affect quarantine and treatment recommendations. Participants were monitored for influenza-like illness (ILI), defined as fever and cough or sore throat, using weekly telephone audio computer-assisted self-interviews. Those with ILI were further evaluated at three HIV specialty clinics. For those with influenza, we collected nasopharyngeal washes every 3 days after the date of confirmed influenza infection for 21-28 days; specimens underwent reverse transcriptase - polymerase chain reaction (RT-PCR) and viral culture. Duration of influenza virus shedding was the interval from the date of onset (day 0) of ILI to the date of last culture-positive specimen. Characteristics were compared between patients with and without influenza using Fisher's exact test. We used the Wilcoxon rank-sum test to examine factors that may have affected influenza virus shedding. From October 2010 to April 2011, we enrolled 961 participants in syndromic surveillance and diagnosed 20 patients with influenza whose characteristics were as follows: median age 48 years (interquartile range [IQR]: 43-53), 60% male, 50% non-Hispanic black, 95% had been prescribed combination highly active antiretroviral therapy (cART), 85% were virologically suppressed (HIV RNA <400 copies/ml), median CD4 cell count 317 cells/mm (IQR: 190-544), and median follow-up time 21 days (IQR: 19-22). Compared with persons without influenza, persons with influenza were more likely to be older, use injection drugs, and have a lower median CD4 cell count and were less likely to have had an influenza vaccination in the past 12 months. Median durations of shedding, PCR detection, and ILI symptoms were 3 (IQR: 0-5), 10 (IQR: 6-15), and 14 days (IQR: 12-26), respectively. Median days of shedding were similar among patients with and without any prior influenza vaccination (0 vs. 4, p = .448), HIV viral suppression (2 vs. 6, p = .053), and oseltamivir use (5 vs. 0, p = .083). HIV-infected persons on cART in our study shed influenza virus for a similar duration as that reported for HIV-uninfected persons.
HIV 感染成人中流感病毒 shedding 的持续时间尚不清楚，这可能会影响隔离和治疗建议。通过每周一次的电话音频计算机辅助自我访谈，对参与者进行流感样疾病（ILI）监测，ILI 定义为发热、咳嗽或喉咙痛。ILI 患者在三家 HIV 专科诊所接受进一步评估。对于流感患者，在确诊流感感染日期后每 3 天收集一次鼻咽冲洗液，持续 21 - 28 天；标本进行逆转录 - 聚合酶链反应（RT-PCR）和病毒培养。流感病毒 shedding 的持续时间是从 ILI 发病日期（第 0 天）到最后一次培养阳性标本的日期。使用 Fisher 精确检验比较有无流感患者的特征。我们使用 Wilcoxon 秩和检验来检查可能影响流感病毒 shedding 的因素。2010 年 10 月至 2011 年 4 月，我们招募了 961 名参与者进行症状监测，诊断出 20 例流感患者，其特征如下：年龄中位数 48 岁（四分位间距[IQR]：43 - 53），60%为男性，50%为非西班牙裔黑人，95%曾接受过联合高效抗逆转录病毒治疗（cART），85%病毒学抑制（HIV RNA <400 拷贝/ml），CD4 细胞计数中位数 317 个/mm（IQR：190 - 544），随访时间中位数 21 天（IQR：19 - 22）。与无流感者相比，流感患者更可能年龄较大、使用注射药物、CD4 细胞计数中位数较低，且在过去 12 个月内接种流感疫苗的可能性较小。shedding、PCR 检测和 ILI 症状的持续时间中位数分别为 3 天（IQR：0 - 5）、10 天（IQR：6 - 15）和 14 天（IQR：12 - 26）。有无任何既往流感疫苗接种（0 天对 4 天，p = 0.448）、HIV 病毒抑制（2 天对 6 天，p = 0.053）和使用奥司他韦（5 天对 0 天，p = 0.083）的患者中，shedding 的天数中位数相似。我们研究中接受 cART 的 HIV 感染者流感病毒 shedding 的持续时间与未感染 HIV 者报告的持续时间相似。
