Influenza A H5N1 and HIV co-infection: case report.
BACKGROUND
The role of adaptive immunity in severe influenza is poorly understood. The occurrence of influenza A/H5N1 in a patient with HIV provided a rare opportunity to investigate this.


METHODS
A 30-year-old male was admitted on day 4 of influenza-like-illness with tachycardia, tachypnea, hypoxemia and bilateral pulmonary infiltrates. Influenza A/H5N1 and HIV tests were positive and the patient was treated with Oseltamivir and broad-spectrum antibiotics. Initially his condition improved coinciding with virus clearance by day 6. He clinically deteriorated as of day 10 with fever recrudescence and increasing neutrophil counts and died on day 16. His admission CD4 count was 100/microl and decreased until virus was cleared. CD8 T cells shifted to a CD27+CD28- phenotype. Plasma chemokine and cytokine levels were similar to those found previously in fatal H5N1.


CONCLUSIONS
The course of H5N1 infection was not notably different from other cases. Virus was cleared despite profound CD4 T cell depletion and aberrant CD8 T cell activation but this may have increased susceptibility to a fatal secondary infection.
Fox
Annette
A
Oxford University Clinical Research Unit Viet Nam, Wellcome Trust Major Overseas Program, National Hospital of Tropical Diseases, 78 Giai Phong Road, Dong Da, Ha Noi, Viet Nam. afox@oucru.org
Horby
Peter
P
Ha
Nguyen Hong
NH
Hoa
Le Nguyen Minh
le NM
Lam
Nguyen Tien
NT
Simmons
Cameron
C
Farrar
Jeremy
J
Van Kinh
Nguyen
N
Wertheim
Heiman
H
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D018106:CD28 Antigens / Q000032:analysis; D018791:CD4 Lymphocyte Count; D018414:CD8-Positive T-Lymphocytes / Q000737:chemistry; D016207:Cytokines / Q000097:blood; D017809:Fatal Outcome; D015483:HIV Antibodies / Q000097:blood; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D053124:Influenza A Virus, H5N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D008297:Male; D053139:Oseltamivir / Q000627:therapeutic use; D018127:Tumor Necrosis Factor Receptor Superfamily, Member 7 / Q000032:analysis
D000900:Anti-Bacterial Agents; D000998:Antiviral Agents; D018106:CD28 Antigens; D016207:Cytokines; D015483:HIV Antibodies; D018127:Tumor Necrosis Factor Receptor Superfamily, Member 7; D053139:Oseltamivir