AEGiS-GMHC: TREATMENT BRIEFS: Controversy Amidst Severe Flu Season

Important note: Information in this article was accurate in 1993. The state of the art may have changed since the publication date.

TREATMENT BRIEFS: Controversy Amidst Severe Flu Season

Gay Men's Health Crisis: Treatment Issues, Volume 7 no. 9 - October, 1993
David Gold

The Centers for Disease Control and Prevention (CDCP) issued a warning that this year's influenza season could start earlier and be more severe than in previous years. The warning is based on reports of recent flu outbreaks in two Louisiana nursing homes. These flu outbreaks occurred earlier than usual. The flu season normally begins in December and peaks in the first two to three months of the year. The CDCP also reports that the strain of flu responsible, Type A Beijing flu, is associated with more severe disease and higher death rates than other strains.

An abstract at the Ninth International AIDS Conference in Berlin has generated controversy because it suggests that flu shots can increase HIV replication. The abstract, from O'Brien and colleagues at UCLA, has received considerable attention in several AIDS newsletters (Abstract PO-A12-0209).

The study examined the amount of replicating virus in sixteen HIV-infected people who received the flu shot. Five HIV- infected people who were not immunized served as controls. Nine of the sixteen immunized subjects had "significant increases in virus replication," measured by infectious virus titers. Viral increases peaked one to two weeks after immunization and approached baseline after "several months." Although the O'Brien abstract has received significant attention, another less-discussed abstract from the conference addresses the same issue, and draws opposite conclusions (Abstract PO-B22-1929.) Yerly and colleagues in Geneva examined viral RNA PCR, HIV provirus in PBMCs by PCR, p24 antigenemia, and CD4 counts before and four weeks after influenza immunization in twelve HIV-infected people (eight adults, four children). No differences were detected in any of the four tests. The authors conclude that "immunizations should thus be part of routine prophylaxis for HIV-infected children and adults, without fear of triggering HIV replication or disease acceleration. "

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