Effect of influenza vaccination on disease progression among HIV-infected persons.
OBJECTIVE
To describe the effect of influenza vaccination on long-term change in CD4 count and HIV RNA level, and on progression to AIDS or death.


METHODS
A longitudinal medical record review set in 113 medical clinics in 10 United States cities.


METHODS
A total of 36,050 HIV-infected persons aged > or = 13 years in care for HIV infection.


METHODS
Change in CD4 count and HIV RNA level at follow-up (3-12 months after vaccination); hazard ratios (HR) for association of influenza vaccine with progression from baseline CD4 or HIV RNA level to AIDS and to death.


RESULTS
The median CD4 count among all persons decreased 28 cells/year during follow-up, with no difference in change in CD4 count between the 8007 (40%) vaccinated (median = 6 months, vaccine to follow-up CD4 count) and the 11,794 unvaccinated persons. In a viral load subanalysis, median HIV RNA level decreased 90 copies/ml per year among all persons during follow-up; decreases were not different between vaccinated and unvaccinated persons (median = 7 months, vaccine to follow-up HIV RNA level determination). Influenza vaccination was weakly associated with decreased risk of progression to clinical AIDS [HR 0.93; 95% confidence interval (CI), 0.87-0.99], but not associated with time to death (HR, 0.97; CI, 0.93-1.01).


CONCLUSIONS
No negative long-term effect of influenza vaccination on CD4 counts, HIV RNA levels, or progression to AIDS or death was found in this HIV-infected population. These data suggest that physicians should not withhold influenza vaccine because of concerns about long-term detrimental effects of increased viral replication.
Sullivan
P S
PS
Division of HIV/AIDS Prevention-Surveillance and Epidemiology, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. pss0@cdc.gov
Hanson
D L
DL
Dworkin
M S
MS
Jones
J L
JL
Ward
J W
JW
D000163:Acquired Immunodeficiency Syndrome / Q000276:immunology / Q000401:mortality / Q000503:physiopathology / Q000821:virology; D000293:Adolescent; D000328:Adult; D018791:CD4 Lymphocyte Count; D000075202:Contraindications; D018450:Disease Progression; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000276:immunology* / Q000401:mortality / Q000503:physiopathology / Q000821:virology*; D015497:HIV-1 / Q000235:genetics / Q000502:physiology; D006801:Humans; D007252:Influenza Vaccines / Q000009:adverse effects*; D007251:Influenza, Human / Q000517:prevention & control; D008297:Male; D012367:RNA, Viral / Q000032:analysis / Q000235:genetics; D044469:Racial Groups; D012307:Risk Factors; D013997:Time Factors; D014611:Vaccination / Q000009:adverse effects; D019562:Viral Load
D007252:Influenza Vaccines; D012367:RNA, Viral