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Comparative Study
. 2012 Oct;55(7):996-1003.
doi: 10.1093/cid/cis549. Epub 2012 Jun 19.

Influenza-related mortality among adults aged 25-54 years with AIDS in South Africa and the United States of America

Cheryl Cohen  1 , Lone Simonsen, Jeannette Sample, Jong-Won Kang, Mark Miller, Shabir A Madhi, Michael Campsmith, Cecile Viboud
Affiliations
Comparative Study

Influenza-related mortality among adults aged 25-54 years with AIDS in South Africa and the United States of America

Cheryl Cohen et al. Clin Infect Dis. 2012 Oct.

Abstract

Background: Data are limited on human immunodeficiency virus (HIV)-associated influenza burden in sub-Saharan Africa and the impact of highly active antiretroviral therapy (HAART). We compared influenza-related mortality in adults with AIDS in South Africa and the United States in the pre-HAART era and evaluated mortality trends after HAART introduction in the United States.

Methods: Monthly all-cause and pneumonia and influenza (P&I) mortality rates were compiled for adults with AIDS aged 25-54 years in South Africa (1998-2005) and the United States (pre-HAART era, 1987-1994; HAART era, 1997-2005). We estimated influenza-related deaths as excess mortality above a model baseline during influenza epidemic periods. Influenza-related mortality rates in adults with AIDS were compared with rates for age peers in the general population and adults ≥65 years old.

Results: In the United States before HAART, influenza-related mortality rates in adults with AIDS were 150 (95% confidence interval [CI], 49-460) and 208 (95% CI, 74-583) times greater than in the general population for all-cause and P&I deaths, respectively, and 2.5 (95% CI, 0.9-7.2) and 4.1 (95% CI, 1.4-13) times higher than in elderly adults. After HAART introduction , influenza-related mortality in adults with AIDS dropped 3-6-fold but remained elevated compared with the general population (all-cause relative risk [RR], 44 [95% CI, 16-121]); P&I RR, 73 [95% CI, 47-113]). Influenza-related mortality in South African adults with AIDS in recent years was similar to that in the United States in the pre-HAART era.

Conclusions: Adults with AIDS experience substantially elevated influenza-associated mortality, which declines with widespread HAART introduction but does not disappear. These data support increased access to HAART and influenza vaccination for HIV-infected adults.

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Figures

Figure 1.
Figure 1.
Monthly number of reported and predicted baseline all-cause and pneumonia and influenza deaths in adults aged 25–54 years with AIDS and influenza epidemic periods, South Africa, 1998–2005; 01 and 07 on horizontal axis signify January and July, respectively. Influenza epidemic periods were identified based on influenza-specific monthly mortality patterns. Abbreviation: P&I, pneumonia and influenza.
Figure 2.
Figure 2.
Monthly number of reported and predicted baseline all-cause and pneumonia and influenza deaths in adults aged 25–54 years with AIDS and influenza epidemic periods, United States, 1987–2005; 01 and 07 on horizontal axis signify January and July, respectively. Influenza epidemic periods were identified based on influenza-specific monthly mortality patterns. Abbreviation: P&I, pneumonia and influenza.
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