Impact of Human Immunodeficiency Virus on the Burden and Severity of Influenza Illness in Malawian Adults: A Prospective Cohort and Parallel Case-Control Study
The impact of human immunodeficiency virus (HIV) infection on influenza incidence and severity in adults in sub-Saharan Africa is unclear. Seasonal influenza vaccination is recommended for HIV-infected persons in developed settings but is rarely implemented in Africa. We conducted a prospective coho...
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| Veröffentlicht in: | Clinical infectious diseases 2018-03, Vol.66 (6), p.865-876 |
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| creator | Ho, Antonia Aston, Stephen J Jary, Hannah Mitchell, Tamara Alaerts, Maaike Menyere, Mavis Mallewa, Jane Nyirenda, Mulinda Everett, Dean Heyderman, Robert S French, Neil |
| description | The impact of human immunodeficiency virus (HIV) infection on influenza incidence and severity in adults in sub-Saharan Africa is unclear. Seasonal influenza vaccination is recommended for HIV-infected persons in developed settings but is rarely implemented in Africa.
We conducted a prospective cohort study to compare the incidence of laboratory-confirmed influenza illness between HIV-infected and HIV-uninfected adults in Blantyre, Malawi. In a parallel case-control study, we explored risk factors for severe influenza presentation of severe (hospitalized) lower respiratory tract infection, and mild influenza (influenza-like illness [ILI]).
The cohort study enrolled 608 adults, of whom 360 (59%) were HIV infected. Between April 2013 and March 2015, 24 of 229 ILI episodes (10.5%) in HIV-infected and 5 of 119 (4.2%) in HIV-uninfected adults were positive for influenza by means of polymerase chain reaction (incidence rate, 46.0 vs 14.5 per 1000 person-years; incidence rate ratio, 2.75; 95% confidence interval, 1.02-7.44; P = .03; adjusted for age, sex, household crowding, and food security). In the case-control study, influenza was identified in 56 of 518 patients (10.8%) with hospitalized lower respiratory tract infection, and 88 or 642 (13.7%) with ILI. The HIV prevalence was 69.6% and 29.6%, respectively, among influenza-positive case patients and controls. HIV was a significant risk factor for severe influenza (odds ratio, 4.98; 95% confidence interval, 2.09-11.88; P < .001; population-attributable fraction, 57%; adjusted for season, sanitation facility, and food security).
HIV is an important risk factor for influenza-associated ILI and severe presentation in this high-HIV prevalence African setting. Targeted influenza vaccination of HIV-infected African adults should be reevaluated, and the optimal mechanism for vaccine introduction in overstretched health systems needs to be determined. |
| doi_str_mv | 10.1093/cid/cix903 |
| format | Article |
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We conducted a prospective cohort study to compare the incidence of laboratory-confirmed influenza illness between HIV-infected and HIV-uninfected adults in Blantyre, Malawi. In a parallel case-control study, we explored risk factors for severe influenza presentation of severe (hospitalized) lower respiratory tract infection, and mild influenza (influenza-like illness [ILI]).
The cohort study enrolled 608 adults, of whom 360 (59%) were HIV infected. Between April 2013 and March 2015, 24 of 229 ILI episodes (10.5%) in HIV-infected and 5 of 119 (4.2%) in HIV-uninfected adults were positive for influenza by means of polymerase chain reaction (incidence rate, 46.0 vs 14.5 per 1000 person-years; incidence rate ratio, 2.75; 95% confidence interval, 1.02-7.44; P = .03; adjusted for age, sex, household crowding, and food security). In the case-control study, influenza was identified in 56 of 518 patients (10.8%) with hospitalized lower respiratory tract infection, and 88 or 642 (13.7%) with ILI. The HIV prevalence was 69.6% and 29.6%, respectively, among influenza-positive case patients and controls. HIV was a significant risk factor for severe influenza (odds ratio, 4.98; 95% confidence interval, 2.09-11.88; P < .001; population-attributable fraction, 57%; adjusted for season, sanitation facility, and food security).
HIV is an important risk factor for influenza-associated ILI and severe presentation in this high-HIV prevalence African setting. Targeted influenza vaccination of HIV-infected African adults should be reevaluated, and the optimal mechanism for vaccine introduction in overstretched health systems needs to be determined.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1093/cid/cix903</identifier><identifier>PMID: 29045699</identifier><language>eng</language><publisher>United States: Oxford University Press</publisher><subject>Adult ; and Commentaries ; Case-Control Studies ; Cost of Illness ; Female ; HIV - isolation & purification ; HIV Infections - complications ; HIV Infections - epidemiology ; Hospitalization - statistics & numerical data ; Humans ; Incidence ; Influenza, Human - epidemiology ; Malawi - epidemiology ; Male ; Middle Aged ; Orthomyxoviridae - genetics ; Orthomyxoviridae - isolation & purification ; Prevalence ; Prospective Studies ; Risk Factors ; Seasons ; Severity of Illness Index</subject><ispartof>Clinical infectious diseases, 2018-03, Vol.66 (6), p.865-876</ispartof><rights>The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.</rights><rights>The Author(s) 2017. Published by Oxford University Press for the Infectious Diseases Society of America. 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c378t-dd22fd9f16059ab82a36f0baedc5982b1473fd14071f2bcb56759d72912c56ba3</citedby><cites>FETCH-LOGICAL-c378t-dd22fd9f16059ab82a36f0baedc5982b1473fd14071f2bcb56759d72912c56ba3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29045699$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ho, Antonia</creatorcontrib><creatorcontrib>Aston, Stephen J</creatorcontrib><creatorcontrib>Jary, Hannah</creatorcontrib><creatorcontrib>Mitchell, Tamara</creatorcontrib><creatorcontrib>Alaerts, Maaike</creatorcontrib><creatorcontrib>Menyere, Mavis</creatorcontrib><creatorcontrib>Mallewa, Jane</creatorcontrib><creatorcontrib>Nyirenda, Mulinda</creatorcontrib><creatorcontrib>Everett, Dean</creatorcontrib><creatorcontrib>Heyderman, Robert S</creatorcontrib><creatorcontrib>French, Neil</creatorcontrib><title>Impact of Human Immunodeficiency Virus on the Burden and Severity of Influenza Illness in Malawian Adults: A Prospective Cohort and Parallel Case-Control Study</title><title>Clinical infectious diseases</title><addtitle>Clin Infect Dis</addtitle><description>The impact of human immunodeficiency virus (HIV) infection on influenza incidence and severity in adults in sub-Saharan Africa is unclear. Seasonal influenza vaccination is recommended for HIV-infected persons in developed settings but is rarely implemented in Africa.
We conducted a prospective cohort study to compare the incidence of laboratory-confirmed influenza illness between HIV-infected and HIV-uninfected adults in Blantyre, Malawi. In a parallel case-control study, we explored risk factors for severe influenza presentation of severe (hospitalized) lower respiratory tract infection, and mild influenza (influenza-like illness [ILI]).
The cohort study enrolled 608 adults, of whom 360 (59%) were HIV infected. Between April 2013 and March 2015, 24 of 229 ILI episodes (10.5%) in HIV-infected and 5 of 119 (4.2%) in HIV-uninfected adults were positive for influenza by means of polymerase chain reaction (incidence rate, 46.0 vs 14.5 per 1000 person-years; incidence rate ratio, 2.75; 95% confidence interval, 1.02-7.44; P = .03; adjusted for age, sex, household crowding, and food security). In the case-control study, influenza was identified in 56 of 518 patients (10.8%) with hospitalized lower respiratory tract infection, and 88 or 642 (13.7%) with ILI. The HIV prevalence was 69.6% and 29.6%, respectively, among influenza-positive case patients and controls. HIV was a significant risk factor for severe influenza (odds ratio, 4.98; 95% confidence interval, 2.09-11.88; P < .001; population-attributable fraction, 57%; adjusted for season, sanitation facility, and food security).
HIV is an important risk factor for influenza-associated ILI and severe presentation in this high-HIV prevalence African setting. Targeted influenza vaccination of HIV-infected African adults should be reevaluated, and the optimal mechanism for vaccine introduction in overstretched health systems needs to be determined.</description><subject>Adult</subject><subject>and Commentaries</subject><subject>Case-Control Studies</subject><subject>Cost of Illness</subject><subject>Female</subject><subject>HIV - isolation & purification</subject><subject>HIV Infections - complications</subject><subject>HIV Infections - epidemiology</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Humans</subject><subject>Incidence</subject><subject>Influenza, Human - epidemiology</subject><subject>Malawi - epidemiology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Orthomyxoviridae - genetics</subject><subject>Orthomyxoviridae - isolation & purification</subject><subject>Prevalence</subject><subject>Prospective Studies</subject><subject>Risk Factors</subject><subject>Seasons</subject><subject>Severity of Illness Index</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkduKFDEQhhtR3HX1xgeQXIrQmkOnu-OFMDbqNqy4sOptSOfgRNLJmMPo-DK-qllnXfSiqIL666ui_qZ5jOBzBBl5Ia2q8YNBcqc5RZQMbU8ZultrSMe2G8l40jxI6SuECI2Q3m9OMIMd7Rk7bX7N607IDIIB52UVHszrWnxQ2lhptZcH8NnGkkDwIG81eF2i0h4Ir8CV3uto8-F6dPbGFe1_CjA753VKwHrwXjjx3VbkRhWX00uwAZcxpJ2W2e41mMI2xPwHdSmicE47MImk2yn4HIMDV7mow8PmnhEu6Uc3-az59PbNx-m8vfjwbp42F60kw5hbpTA2ihnUQ8rEMmJBegMXoZWkbMQL6gZiFOrggAxe5EL7gTI1YIawpP0iyFnz6sjdlWWtU7reIBzfRbuKeOBBWP5_x9st_xL2nI4U0r6rgKc3gBi-FZ0yX22S2jnhdSiJI0YJZpQOuEqfHaWyviNFbW7XIMivHeXVUX50tIqf_HvYrfSvheQ329qg9Q</recordid><startdate>20180305</startdate><enddate>20180305</enddate><creator>Ho, Antonia</creator><creator>Aston, Stephen J</creator><creator>Jary, Hannah</creator><creator>Mitchell, Tamara</creator><creator>Alaerts, Maaike</creator><creator>Menyere, Mavis</creator><creator>Mallewa, Jane</creator><creator>Nyirenda, Mulinda</creator><creator>Everett, Dean</creator><creator>Heyderman, Robert S</creator><creator>French, Neil</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20180305</creationdate><title>Impact of Human Immunodeficiency Virus on the Burden and Severity of Influenza Illness in Malawian Adults: A Prospective Cohort and Parallel Case-Control Study</title><author>Ho, Antonia ; Aston, Stephen J ; Jary, Hannah ; Mitchell, Tamara ; Alaerts, Maaike ; Menyere, Mavis ; Mallewa, Jane ; Nyirenda, Mulinda ; Everett, Dean ; Heyderman, Robert S ; French, Neil</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c378t-dd22fd9f16059ab82a36f0baedc5982b1473fd14071f2bcb56759d72912c56ba3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adult</topic><topic>and Commentaries</topic><topic>Case-Control Studies</topic><topic>Cost of Illness</topic><topic>Female</topic><topic>HIV - isolation & purification</topic><topic>HIV Infections - complications</topic><topic>HIV Infections - epidemiology</topic><topic>Hospitalization - statistics & numerical data</topic><topic>Humans</topic><topic>Incidence</topic><topic>Influenza, Human - epidemiology</topic><topic>Malawi - epidemiology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Orthomyxoviridae - genetics</topic><topic>Orthomyxoviridae - isolation & purification</topic><topic>Prevalence</topic><topic>Prospective Studies</topic><topic>Risk Factors</topic><topic>Seasons</topic><topic>Severity of Illness Index</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ho, Antonia</creatorcontrib><creatorcontrib>Aston, Stephen J</creatorcontrib><creatorcontrib>Jary, Hannah</creatorcontrib><creatorcontrib>Mitchell, Tamara</creatorcontrib><creatorcontrib>Alaerts, Maaike</creatorcontrib><creatorcontrib>Menyere, Mavis</creatorcontrib><creatorcontrib>Mallewa, Jane</creatorcontrib><creatorcontrib>Nyirenda, Mulinda</creatorcontrib><creatorcontrib>Everett, Dean</creatorcontrib><creatorcontrib>Heyderman, Robert S</creatorcontrib><creatorcontrib>French, Neil</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ho, Antonia</au><au>Aston, Stephen J</au><au>Jary, Hannah</au><au>Mitchell, Tamara</au><au>Alaerts, Maaike</au><au>Menyere, Mavis</au><au>Mallewa, Jane</au><au>Nyirenda, Mulinda</au><au>Everett, Dean</au><au>Heyderman, Robert S</au><au>French, Neil</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of Human Immunodeficiency Virus on the Burden and Severity of Influenza Illness in Malawian Adults: A Prospective Cohort and Parallel Case-Control Study</atitle><jtitle>Clinical infectious diseases</jtitle><addtitle>Clin Infect Dis</addtitle><date>2018-03-05</date><risdate>2018</risdate><volume>66</volume><issue>6</issue><spage>865</spage><epage>876</epage><pages>865-876</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><abstract>The impact of human immunodeficiency virus (HIV) infection on influenza incidence and severity in adults in sub-Saharan Africa is unclear. Seasonal influenza vaccination is recommended for HIV-infected persons in developed settings but is rarely implemented in Africa.
We conducted a prospective cohort study to compare the incidence of laboratory-confirmed influenza illness between HIV-infected and HIV-uninfected adults in Blantyre, Malawi. In a parallel case-control study, we explored risk factors for severe influenza presentation of severe (hospitalized) lower respiratory tract infection, and mild influenza (influenza-like illness [ILI]).
The cohort study enrolled 608 adults, of whom 360 (59%) were HIV infected. Between April 2013 and March 2015, 24 of 229 ILI episodes (10.5%) in HIV-infected and 5 of 119 (4.2%) in HIV-uninfected adults were positive for influenza by means of polymerase chain reaction (incidence rate, 46.0 vs 14.5 per 1000 person-years; incidence rate ratio, 2.75; 95% confidence interval, 1.02-7.44; P = .03; adjusted for age, sex, household crowding, and food security). In the case-control study, influenza was identified in 56 of 518 patients (10.8%) with hospitalized lower respiratory tract infection, and 88 or 642 (13.7%) with ILI. The HIV prevalence was 69.6% and 29.6%, respectively, among influenza-positive case patients and controls. HIV was a significant risk factor for severe influenza (odds ratio, 4.98; 95% confidence interval, 2.09-11.88; P < .001; population-attributable fraction, 57%; adjusted for season, sanitation facility, and food security).
HIV is an important risk factor for influenza-associated ILI and severe presentation in this high-HIV prevalence African setting. Targeted influenza vaccination of HIV-infected African adults should be reevaluated, and the optimal mechanism for vaccine introduction in overstretched health systems needs to be determined.</abstract><cop>United States</cop><pub>Oxford University Press</pub><pmid>29045699</pmid><doi>10.1093/cid/cix903</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Clinical infectious diseases, 2018-03, Vol.66 (6), p.865-876 |
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| source | Jstor Complete Legacy; Oxford University Press Journals All Titles (1996-Current); MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Adult and Commentaries Case-Control Studies Cost of Illness Female HIV - isolation & purification HIV Infections - complications HIV Infections - epidemiology Hospitalization - statistics & numerical data Humans Incidence Influenza, Human - epidemiology Malawi - epidemiology Male Middle Aged Orthomyxoviridae - genetics Orthomyxoviridae - isolation & purification Prevalence Prospective Studies Risk Factors Seasons Severity of Illness Index |
| title | Impact of Human Immunodeficiency Virus on the Burden and Severity of Influenza Illness in Malawian Adults: A Prospective Cohort and Parallel Case-Control Study |
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