Do HIV-Positive People Have Worse Flu Symptoms, or Do Physicians Just Think They Do?

An Interview With Christina Schofield, M.D.

Contributing Editor
Christina Schofield, M.D.
Christina Schofield, M.D.

Flu season can bring anxiety for people living with HIV and their health care providers. But do HIV-positive people have more severe symptoms of flu than people who are not living with HIV? In a first-of-its-kind analysis, a multi-site network of military treatment facilities located across the United States looked at influenza-like illness (ILI) in an otherwise healthy, adult outpatient cohort including individuals living with HIV. Christina Schofield, M.D., an adult infectious disease physician at Madigan Army Medical Center in Tacoma, Wash., is involved in the study. At IDWeek 2015 in San Diego, Calif., Dr. Schofield shared with me some illuminating findings -- and a succinct takeaway for providers treating patients living with HIV.

Dr. Schofield, thanks so much for speaking with me. Tell us about your study.

Since 2009, we've been prospectively enrolling folks that present with ILI into an observational cohort. They are predominantly outpatients without significant comorbidities; 7.5% of those enrolled are living with HIV.

We looked at factors such as symptom severity, clinical outcomes, viral etiologies, and basically found pretty similar severity between HIV-positive and HIV-negative patients.

We actually saw higher upper respiratory symptom scores in HIV-negative folks than HIV-positive -- and a few individual gastrointestinal and systemic symptoms are higher in the HIV-positive patients. But overall, pretty similar.

Despite the fact that symptoms were not more severe for patients living with HIV, there were higher rates of hospitalization in HIV-positive individuals. There were also higher rates of use of antibiotics in individuals living with HIV.

Talk a little bit about that finding.

There's probably a little bit of physician bias, and a bit more cautious treatment toward patients that are HIV positive, despite the fact that our patient population is a very healthy HIV-positive population. Our average CD4+ count on enrollment was 492, and then at the 28-day mark it was 612. So, again, we have well-controlled HIV: The vast majority of patients are on medications with undetectable viral loads.

Viral etiologies were pretty similar. There was a little bit more influenza B detected in HIV-positive individuals, but otherwise, similar. And HIV-related parameters were generally stable. Absolute CD4+ count was suppressed at enrollment and then came back up at day 28, but CD4+ percentage stayed the same and viral load stayed the same.

What's the takeaway for providers from the results of this study?

I would say that, just because somebody's got HIV doesn't mean they're going to have more severe disease. If they're a healthy HIV patient, don't bias yourself toward hospital admission just because of that one factor; look at the whole patient.

This transcript has been lightly edited for clarity.