Swine ’flu and HIV - Advice for people with HIV in Merseyside, Cheshire and North Wales (July 2009)
Little is known about “Swine ‘flu” (or Pandemic Influenza A/H1N1) and HIV, but we assume that it will behave like the other forms of ‘flu that occur every year.
There is little evidence that any form of ‘flu is either more common or severe in people with HIV than in other people. However, it is possible that people whose immune system is badly affected by HIV (meaning those with very low CD4 counts) are more likely to get pneumonia and other complications soon after having flu. This is why people with HIV are encouraged to have flu jabs every year to stop them getting flu, and to consult their doctors if they do have flu, in case antibiotics are needed. See BHIVA 2008 guidelines on http://www.bhiva.org/files/file1031135.pdf
Current government guidance is that the general population should NOT go to their doctor or to hospital if they think they have swine flu, but to consult NHS Direct on 0845 4647 or on www.nhs.uk/AlertsEmergencies/Pages/Pandemicflualert.aspx, the new the National Pandemic Flu Service helpline 0800 1 513 100 or via the internet www.pandemicflu.direct.gov.uk/ to check their symptoms and to obtain drugs like Tamiflu if necessary.
The same sort of advice applies to people with HIV, and some recent general guidance has been given by the Terrence Higgins Trust, which we endorse www.tht.org.uk/howwecanhelpyou/livingwithhiv/swinefluandhiv/. Please note that the advice given changes as we learn more about swine flu, so always check the information sources given for the latest advice.
The specialist doctors, nurses and pharmacists of the Mersey, Cheshire and North Wales HIV Network have produced the following answers to some common questions about HIV and swine flu which we hope will help you:
Q. Is swine flu more common or serious in people with HIV?
A. No it is not more common. Some people with very weak immune systems (CD4 count less than 200) may be more likely to get pneumonia and other complications in the two weeks following an attack of flu.
Q. What should I do if I think I might have swine flu?
A. Ring NHS Direct on 0845 4647 or the National Pandemic Flu Service Helpline on 0800 1 513 100 or on-line at www.pandemicflu.direct.gov.uk/ and follow the instructions.
Q. I have followed the advice, and this says I should take Tamiflu (oseltamivir) or Relenza (zanamavir). Are these drugs safe in people with HIV, or will they interact with my other drugs including HIV therapy (HAART)?
A. We think these drugs are just as safe and effective in people with HIV as in others. They seem to have few major effects on HAART and other HIV related drugs but you can check this on the Liverpool website which has details of all drug interactions on www.hiv-druginteractions.org/ . If you have severe kidney problems, it might be better to use Relenza instead of Tamiflu.
Q. Should I go to the HIV clinic if I think I have swine flu?
A. No. You should use the facilities above, or if you think you need to see a doctor, consult with your general practitioner or an NHS walk-in centre. DO NOT go to hospital clinics or A&E departments.
Q. I don’t have a GP, what should I do?
A. Use the above resources. In future, you should register with a GP for your everyday health requirements, and this is a good example of the reason why. HIV clinics are specialist services for HIV care and patients with possible ‘flu should be assessed elsewhere.
Q. Can I get Tamiflu or Relenza from the hospital?
A. No. Hospital clinics (including HIV clinics), A&E departments and pharmacies are not allowed to provide these drugs, except for inpatients. You will have to obtain them through the community services.
Q. I have recently been exposed to a person diagnosed as having swine flu. Should I take Tamiflu?
A. In general, “prophylaxis”, which means taking Tamiflu to stop you catching flu after exposure to a case, is not advised. However, the Health Protection Agency (HPA) currently recommends that people with immunosuppression should obtain Tamiflu prophylaxis after a prolonged close, recent, exposure to a case, as defined on the HPA website http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1243581475043
We suggest that this is only necessary if your CD4 count is less than 200 (whether you are taking HAART or not).
Q. If I think I need Tamiflu prophylaxis, how do I get it?
A. You may need to discuss this with your general practitioner on the telephone (rather than attending the clinic). You will not be able to obtain it from the hospital clinics or A&E department or pharmacy.
Q. I do not want to tell my GP about my HIV status
A. That is your decision, but means you will not be able to get the best possible advice about treatment or prophylaxis for influenza (or indeed other problems)
Q. Should I have the flu jab, and how can I get it?
A. All people with HIV are encouraged to have yearly flu jabs, usually from their GP, or possibly through their HIV clinic. When these become available in the autumn, you should arrange to have this. It will probably not provide much protection from swine flu.
Q. What about the new swine flu jabs?
A. These are different from the ordinary flu jabs, and should also be available in late autumn 2009, although we are waiting to hear exactly when, and in what form. It will probably consist of 2 separate jabs. Your local HIV clinic will probably let you know after summer how to obtain the new swine flu vaccine.
Q. What if I have other questions about HIV and swine flu?
A. Most should be answered by the links provided. If these do not help, you can speak to your GP or your usual contact in your HIV clinic by phone.
Q. I am about to run out of my HIV medications but might have ‘flu. What should I do?
A. Ring your usual contact at your HIV clinic, to arrange for your prescription to be renewed and collected or delivered to you by someone else, and for your appointment to be rearranged for when you have got recovered.
Mersey, Cheshire & North Wales Clinically Managed HIV Network
This version 27 July 2009 swinefluHIV.doc