title: Duration of Influenza Virus Shedding Among HIV-Infected Adults in the cART Era, 2010-2011.
abstract: 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/mm3(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.
authors.affiliation: 1 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia .
authors.forename: Pragna
authors.initials: P
authors.lastname: Patel
authors.affiliation: 1 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia .
authors.forename: Timothy
authors.initials: T
authors.lastname: Bush
authors.affiliation: 2 Department of Infectious Diseases, Brown University , Providence, Rhode Island.
authors.forename: E Milu
authors.initials: EM
authors.lastname: Kojic
authors.affiliation: 3 University of Alabama at Birmingham School of Medicine , Birmingham, Alabama.
authors.forename: Edgar T
authors.initials: ET
authors.lastname: Overton
authors.affiliation: 4 Hennepin County Medical Center, University of Minnesota , Minneapolis, Minnesota.
authors.forename: Keith
authors.initials: K
authors.lastname: Henry
authors.affiliation: 5 Washington University School of Medicine , St. Louis, Missouri.
authors.forename: Nur
authors.initials: N
authors.lastname: Önen
authors.affiliation: 6 Abbott-Northwestern Hospital , Minneapolis, Minnesota.
authors.forename: Frank
authors.initials: F
authors.lastname: Rhame
authors.affiliation: 1 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia .
authors.forename: Lois
authors.initials: L
authors.lastname: Conley
authors.affiliation: 1 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia .
authors.forename: John T
authors.initials: JT
authors.lastname: Brooks
authors.affiliation: 7 Influenza Division, Centers for Disease Control and Prevention , Atlanta, Georgia .
authors.forename: Alicia
authors.initials: A
authors.lastname: Fry
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D007251:Influenza, Human / Q000821:virology*; D008297:Male; D008875:Middle Aged; D009305:Nasopharynx / Q000821:virology; D009975:Orthomyxoviridae / Q000302:isolation & purification*; D011446:Prospective Studies; D012367:RNA, Viral / Q000032:analysis; D020133:Reverse Transcriptase Polymerase Chain Reaction; D013997:Time Factors; D017201:Virus Shedding
chemical_list: D044966:Anti-Retroviral Agents; D012367:RNA, Viral
keywords: HIV; influenza; shedding