Influenzavirus Infection Is a Primary Cause of Febrile Respiratory Illness in HIV-Infected Adults, Despite Vaccination

Abstract

Background. There are, to our knowledge, no prospective studies of respiratory tract infections in human immunodeficiency virus (HIV)—infected adults in the highly active antiretroviral therapy (HAART) era. We performed a surveillance study of outpatients who presented with fever and respiratory symptoms to examine the role of viral pathogens in these patients. Methods. Consecutive patients with a temperature of Results. Fifty patients (90% of whom were receiving HAART) were included in the study (median CD4⁺ T cell count, 325 cells/µL; median HIV RNA level, P = .07). Antibiotic prescriptions were common: 70% of patients received antibiotics. No patients with influenza required hospitalization, compared with 21% of other patients (P = .03). Conclusions. Although illness was mild, influenza accounted for a large proportion of unscheduled visits to a health care provider for respiratory illness and was associated with unnecessary antibiotic prescriptions that may contribute to antimicrobial resistance. Vaccination alone was insufficient to prevent infection. Thus, specific identification and management of influenza should be performed in HIV-infected outpatients who present with fever and respiratory symptoms.