Influenza-related mortality among adults aged 25-54 years with AIDS in South Africa and the United States of America.
BACKGROUND
Data are limited on human immunodeficiency virus (HIV)-associated influenza burden in sub-Saharan Africa and the impact of highly active antiretroviral therapy (HAART). We compared influenza-related mortality in adults with AIDS in South Africa and the United States in the pre-HAART era and evaluated mortality trends after HAART introduction in the United States.


METHODS
Monthly all-cause and pneumonia and influenza (P&I) mortality rates were compiled for adults with AIDS aged 25-54 years in South Africa (1998-2005) and the United States (pre-HAART era, 1987-1994; HAART era, 1997-2005). We estimated influenza-related deaths as excess mortality above a model baseline during influenza epidemic periods. Influenza-related mortality rates in adults with AIDS were compared with rates for age peers in the general population and adults ≥65 years old.


RESULTS
In the United States before HAART, influenza-related mortality rates in adults with AIDS were 150 (95% confidence interval [CI], 49-460) and 208 (95% CI, 74-583) times greater than in the general population for all-cause and P&I deaths, respectively, and 2.5 (95% CI, 0.9-7.2) and 4.1 (95% CI, 1.4-13) times higher than in elderly adults. After HAART introduction , influenza-related mortality in adults with AIDS dropped 3-6-fold but remained elevated compared with the general population (all-cause relative risk [RR], 44 [95% CI, 16-121]); P&I RR, 73 [95% CI, 47-113]). Influenza-related mortality in South African adults with AIDS in recent years was similar to that in the United States in the pre-HAART era.


CONCLUSIONS
Adults with AIDS experience substantially elevated influenza-associated mortality, which declines with widespread HAART introduction but does not disappear. These data support increased access to HAART and influenza vaccination for HIV-infected adults.
National Institute for Communicable Diseases of the National Health Laboratory Service, University of the Witwatersrand, Johannesburg, South Africa. cherylc@nicd.ac.za
Cheryl
C
Cohen
Lone
L
Simonsen
Jeannette
J
Sample
Jong-Won
JW
Kang
Mark
M
Miller
Shabir A
SA
Madhi
Michael
M
Campsmith
Cecile
C
Viboud
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000188:drug therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000008:administration & dosage; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D006801:Humans; D007251:Influenza, Human / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D013019:South Africa / Q000453:epidemiology; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D055815:Young Adult
D019380:Anti-HIV Agents