Flu-Related Mortality 73 Times Higher With AIDS in US cART Era

Even after introduction of combination antiretroviral therapy (cART) in the United States, influenza-related mortality remained 73 times higher in people with AIDS than in the general population. Influenza-related mortality through 2005 in South Africa was similar to that in the United States in the pre-cART era.

Researchers in the United States and South Africa conducted this study to compare influenza-related mortality in adults with AIDS in South Africa and in the United States in the pre-cART era and after introduction of cART. The analysis focused on 25- to 54-year-olds with AIDS in South Africa from 1998 through 2005 and AIDS patients the same age in the United States in the pre-cART era (1987-1994) and the early cART era (1997-2005).

The investigators estimated influenza-related deaths as “excess mortality above a model baseline during influenza epidemic periods.” They compared all-cause and influenza-related mortality in adults with AIDS and age peers in the general population as well as adults 65 years old and older.
Before introduction of cART in the United States, all-cause mortality in adults with AIDS was 150 times greater than in the age-matched general population and pneumonia- and influenza-related mortality was 208 times greater than in the general population. In those years these middle-aged AIDS patients had a 2.5 times higher rate of all-cause mortality and a 4.1 times higher rate of pneumonia and influenza death than did people 65 and older.
Influenza-related mortality in South African adults with AIDS in 1998-2005 was similar to the rate in US adults during the pre-cART era.
In the United States, influenza-related mortality in adults with AIDS dropped 3- to 6-fold with widespread use of cART. But all-cause mortality in adults with AIDS remained 44 times higher than in the age-matched general population, and pneumonia- and influenza-related mortality remained 73 times higher than in the general population.
The researchers conclude that “adults with AIDS experience substantially elevated influenza-associated mortality, which declines with widespread [cART] introduction but does not disappear.”
They believe their findings “support increased access to [cART] and influenza vaccination for HIV-infected adults.”
Source: Cheryl Cohen, Lone Simonsen, Jeannette Sample, Jong-Won Kang, Mark Miller, Shabir A. Madhi, Michael Campsmith, Cecile Viboud. Influenza-related mortality among adults aged 25-54 years with AIDS in South Africa and the United States of America. Clinical Infectious Diseases. 2012; 55: 996-1003.

For the study abstract
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Written by Mark Mascolini on behalf of the International AIDS Society