Children who had influenza like illness (ILI) were admitted to an isolation ward or ICU depending on their clinical condition. HIV infection was suspected in those children who had failure to thrive, history of recurrent infections or those whose parents reported high risk behavior. Four children were diagnosed seropositive after admission for suspected H1N1. Three consecutive ELISA tests were used to diagnose HIV infection in children older than 18 months. In case of the 4 month old child, HIV DNA PCR was used to confirm HIV infection. H1N1 infection was confirmed by RT-PCR.

The age of children who were HIV and H1N1 positive ranged from 2 to 10 years. Severe hypoxemia was seen in two children which responded well to bubble CPAP. Chest X-ray showed unilateral or bilateral parahilar infiltrates, similar to those seen in children who were HIV negative but H1N1 positive. CD 4 counts and CD percentage (for children >5 and <5 years, respectively). in children who were HIV and H1N1 positive were in the range for which initiation of ART is recommended. Blood cultures were sterile in all children. All five children were discharged home on anti-retroviral therapy. Details are shown in Table I.

TABLE I



Clinical and Laboratory Features, and Outcome of HIV Positive Children with H1N1

The presentation of children who had HIV infection and tested positive for HIV was similar to those who were HIV negative i.e. cough, cold and fever followed by respiratory distress (Unpublished data). Only one child presented with respiratory symptoms and parotid enlargement which could be attributed to either HIV infection itself or to H1N1 infection.

Children who were HIV positive with H1N1 were treated in the same way as the HIV negative, H1N1 positive patients (i.e. oseltamivir, broad spectrum antibiotics, bubble CPAP and oxygen). The mean hospital stay was also similar in these two groups i.e. 7 days (Unpublished data). All children tolerated oseltamivir well with no adverse effects. All patients were empirically given intra-venous antibiotics and oral cotrimoxazole in view of the likely immunosuppressed status and possibility of serious bacterial and P. jarivi infection.

High index of suspicion and early treatment can reduce the rate of complications and mortality in these patients. HIV-infected persons should be considered as a high risk and a priority population for preventive and therapeutic strategies against influenza including emerging influenza A (H1N1) virus infection.

Persons with HIV infection should be considered for post-exposure prophylaxis with oseltamivir, prophylaxis being continued for 10 days after the last known exposure to an suspected or confirmed case [5]. Post-exposure prophylaxis is recommended for HIV-infected persons who are household contacts of individuals with influenza A (H1N1).

Contributors: RK and CV collected patients’ records, performed data analysis and drafted the manuscript. AK and RK contributed to data acquisition and performed the review of the literature. All authors approved the final manuscript.

Funding: None. Competing interests: None stated.