Please see the related links box for general swine flu information.

For information on how swine flu can affect patients with HIV please see below:

• The outcome of exposure to H1N1 virus
• Risk of catching swine flu
• Risk of developing swine flu illness
• Would annual flu vaccine protect you against H1N1 infection?
• What can you do to protect yourself from H1N1 infection?
• What to do if you are in contact with people with swine flu
• Is there any interaction between antiretroviral agents and anti-novel H1N1 drugs?
• How long should you take anti-novel H1N1 drugs?

The outcome of exposure to H1N1 virus

Individuals exposed to H1N1 virus may develop swine flu illness. The severity of illness varies and depends on individual's background immune status. It is likely that HIV infected patients with low CD4 count may be at higher risk of developing severe form of the illness.

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Risk of catching swine flu

HIV infection reduces CD4 number and function. Human immune system can still fight the swine flu virus to a degree. Data so far do not show HIV infected patients are at higher risk of catching swine flu virus than normal population.

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Risk of developing swine flu illness

Swine flu illness may develop at higher rate amongst HIV infected patients with CD4 count of less than 250 cells/mm³ and not on antiretroviral therapy. Patients with CD4 count of less than 250 cells/mm³ need to contact HIV department to start anti HIV treatment as soon as possible.

People older than 65, children younger than 5, pregnant women, patients with chronic conditions (asthma, diabetes, COPD, renal, hepatic, or heart disease [but not high blood pressure]), patients on long term aspirin therapy may also be at high risk of developing swine illness.

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Would annual flu vaccine protect you against H1N1 infection?

The annual flu vaccines protect against seasonal Novel H1N1 virus infection. H1N1 virus causing swine flu illness in humans is different from the seasonal H1N1 virus.

Receipt of seasonal influenza vaccine may result in protection against H1N1 virus amongst only 25% of adults. Data also indicate that one third of individuals older than 60 may have some form of immunity against H1N1 Virus. Annual flu vaccine is therefore unlikely to protect everyone against swine flu illness.

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What can you do to protect yourself from H1N1 infection?

Make good hygiene a habit for yourself and your children by following the information below:

• Wash hands frequently with soap and water
• Use a paper towel to dry your hands and if you use cloth towels, wash them daily
• Avoid touching your eyes, nose or mouth with your hands. Virus spread this way
• Cover your mouth and nose with tissue when coughing or sneezing
• Dispose of used tissue in the bin
• Cough or sneeze into your upper sleeve if you don’t have a tissue
• Wash your hands after coughing or sneezing
• Clean hard surfaces, like door handles frequently using normal cleaning products
• Stay at home if you are sick
• Stop smoking, smoking suppresses the natural immunity in your lungs
• Eat a balanced diet; including plenty of vegetables, fruits and whole grain products. Also include low fat diary products, lean meats, poultry, fish and beans
• Drink lots of water
• Reduce your salt, sugar and alcohol intake
• Avoid contact with sick people
• Take your anti-retroviral drugs fully and regularly

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What to do if you are in contact with people with swine flu

HIV-infected patients who are close contacts of persons with H1N1 flu virus should receive antiviral treatment.

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Is there any interaction between antiretroviral agents and anti-novel H1N1 drugs?

There are two agents active against novel H1N1 virus; tamiflu^® (taken as tablets) and relenza^® (administered via inhalers). There are little data available on the interaction between anti HIV treatment and these agents. It is likely that protease inhibitors (kaletra, atazanavir, darunavir) may interact with tamiflu^® and increase the rate of side effects associated with tamiflu^®.

The current advice is to take the drugs and inform your doctor if you developed any side effects. The most significant side effects include neurological and those reducing kidney function. Relenza^® is believed to be safe with anti HIV treatment regimes.

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How long should you take anti-novel H1N1 drugs?

Duration of treatment for swine flu virus in HIV infected patients is unknown. Because of the effect of HIV on immune system treatment duration may be longer than that of general population. You will need to take the treatment until complete resolution of your symptoms.

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