HIV and swine flu – patient leaflet

HIV Treat Bull - 2009 Jul/Aug;10(7/8): 03

HIV patients may come into contact with hospital services in various ways. Flow diagram A outlines a suggested protocol for 2 of a common scenarios: telephone contact to members of the HIV team or unplanned presentation to HIV/ID/GUM outpatient clinics.

Treatment

• Flu antivirals should be obtained by the patients calling the pandemic flu service line on 0800 1513 100 / 0800 1513 200 or visiting the website:

• Oseltamivir (Tamiflu) is the currently recommended first-line flu antiviral for most HIV patients and it should be commenced immediately. The dose is 75 mg bd for 5 days.
• In patients with significant renal impairment (eGFR <40 ml/min) or pregnant women we would consider using inhaled zanamivir (Relenza) as an alternative. However, If symptoms are significant, discussion should be sought with senior member of the HIV team with regards to the use of osteltamivir.
• Inhaled zanamivir: Two 5 mg blisters are to be inhaled (using the ‘Diskhaler‘) twice a day for at least five days (equivalent to 10mg twice a day for five days). The patient needs to be capable of using disk haler for administration.
• If intolerant of zanamivir, oseltamivir may be used with caution +/- dose modification. For further information contact ID/ HIV/GU registrar on call [INSERT NUMBER AND BLEEP].

Prophylactic/post exposure treatment

• For HIV positive patients with CD4 > 200 or >15% we would not routinely recommend prophylaxis but instead suggest standard treatment IF the patients develops symptoms and meets the flu criteria above.
• For HIV positive patients with CD4 <200 or <14% prophylaxis may be considered in cases of significant exposure. However to date there is no data to suggest that these individuals are at increased risk of severe disease.
• Please remember in patients with CD4 counts <200 or <14% other opportunistic infections may present with flu like symptoms and patients should have diagnostic swabs to aid diagnosis and be discussed with a senior HIV doctor or ID/HIV/GUM SPR on call.
• For a usable definition we have classified significant exposure as sitting <1 metre from an infected individual for >1 hr.
• The oseltamivir (Tamiflu) dose when used as prophylaxisis 75 mg od for 10 days.
• Inhaled zanamivir: Two 5mg blisters are to be inhaled (using the ‘Diskhaler‘) once a day for at least ten days (equivalent to 10mg twice a day for five days) The patient needs to be capable of using diskhaler administration.

Diagnostic swabs for influenza

• Although swabbing is now not routinely being performed we would advocate taking swabs in individuals infected with HIV as knowledge of negative results may be useful. The patient does not have to attend hospital for this and can be organised via GP or flu treatment centres.

2009-07-10
IB2009-07-03

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