NAPWA

Last year there was concern that the H1N1 (swine fluA highly contagious and relatively common viral infection of the respiratory system, transmitted by infected droplets of moisture which may be spread through coughing and sneezing. Most people with flu recover but some go on to develop secondary infections such as pneumonia which may be fatal.) virus would have a major impact on the health of PLHIVPerson (or people) Living with HIV. This term is now preferred over the older PLWHA.. Fortunately this was not the case with most people experiencing only mild to moderate symptoms which then resolved within a fortnight.

This year’s combined vaccine offers protection against three flu strains: two types of seasonal flu which are expected to recur this season plus the H1N1. This ‘trivalent’ vaccine is available free to PLHIV under the government’s national immunisation program.

If you have already been vaccinated with the 2009 H1N1 vaccine you can choose to receive only the 2010 seasonal flu vaccine. But either way, consider getting vaccinated as soon as possible to ensure you have protection against all three flu strains that are expected to circulate this winter.

PneumoniaAn inflammation of the lung, usually caused by infection with bacteria or other microorganisms, in which the air sacs of the lung become filled with inflammatory cells which solidify and inhibit breathing. is a common, serious consequence of flu. This should be enough incentive for all PLHIV to get vaccinated.

Pneumonia is still seen in higher incidence amongst people with HIV. One Danish study1 which included 3516 PLHIV looked at the incidence of hospital admissions for pneumonia over the period 1995-2007. They found that even as late as 2007 the risk of first-time hospitalisation for pneumonia remained six-times higher for those with HIV than for the general population. This increased risk was observed in those with normal CD4+ cell counts (>500) and was even higher in those with lower counts.

The researchers found that the biggest risk factors were: a low current CD4+ cell count; injecting drug use as the mode of HIV transmission; and, among treatment-näive patients, a high current viral loadA measurement of the quantity of HIV RNA in the blood. Viral load blood test results are expressed as the number of copies (of HIV) per milliliter of blood plasma.. Smoking is also a significant known risk factor for pneumonia but one on which the Danish study did not have data.

While it is true that antiretroviralA medication or other substance which is active against retroviruses such as HIV. treatment has helped reduce the incidence of pneumonia (by more than 60% since it first became available in Denmark in 1995), PLHIV still remain more susceptible to contracting pnuemonia.

The super bugs

In early 2008 there was an almost hysterical media reporting of an increase in the incidence of multi-drug resistantHIV which has mutated and is less susceptible to the effects of one or more anti-HIV drugs is said to be resistant. staph infections in men who have sex with men in San Francisco and Boston. What was touted as ‘the new AIDS’ was actually a case of ill-informed reporting.

Staphylococcal species (Staph) typically lives on most people’s skin and in their nasal passages and only becomes dangerous when it penetrates the skin. It’s not confined at all to gay men or MSM.

One US study2 has shown that MSM are at a significantly increased risk (around 13 times) of having Community-associated Methicillin-resistant Staphylococcus Aureus (CA-MRSA). This is a significant staph infection which is acquired not in a hospital or healthcare setting but in the community. The bug is resistant to antibiotics which can normally treat it.

CA-MRSA can cause significant disease including: skin and soft tissue infections (including abscesses, cellulitis, ulceration and wound infections); sepsis (sometimes called blood poisoning); and pneumonia.

Since this study was published there have been several others which add further evidence that CA-MRSA is a significant issue for MSM, particularly those who are living with HIV.

In April, a study3 of PLHIV treated for staph-related skin and soft tissue infections in Chicago hospitals found that the incidence of these kinds of infections was six times higher in PLHIV compared to the general community and that the incidence is increasing (four-fold from 2003 to 2007).

Another study in San Diego4 of around 500 PLHIV found that, over a seven year period, around 7% acquired MRSA skin and soft tissue infections. Of these almost half had a recurrence of their staph infection.

The strain of MRSA which was most often identified is associated with some severe soft tissue infections. There was evidence that PLHIV who were ‘doing it tough’ (e.g. those in crisis accommodation) were at a higher risk.

PLHIV who had viral loads greater than 1000 copies were much more likely to have recurrences of their infections.

The healthcare-associated form of MRSA has been rife in hospitals for more than a half century, generally infecting people with weakened immune systems.

In Australia, cases of CA-MRSA have escalated in recent years. While it is not being seen in huge amounts, the risk to PLHIV is significant and therefore people should be aware of the risks and symptoms.

The Bottom line

All these studies point to an increased risk for PLHIV of reasonably unpleasant if not dangerous bacterial infections. It all sounds like a real bug-bear! However, you can take some very simple steps to reduce this risk.

For the flu

• Get vaccinated
• Wash your hands often using soap and hot water or a liquid hand sanitizer
• Avoid touching your eyes, nose and mouth and wash your hands after blowing your nose or sneezing
• Keep warm (stay out of the cold and wear warm clothes, especially around the head, face and neck)
• Avoid contact with people who have the flu
• Ensure that your eating and drinking gear is clean

For pneumonia

• Commit to quitting smoking

If you do get the flu:

• Visit your doctor and re-visit if symptoms worsen
• Rest and stay warm
• Drink plenty of warm fluids like soups and tea
• Take paracetamol to reduce fever and aches

For CA-MRSA

Staph lives happily in gyms, locker rooms, prisons, needles and sex on premises venues. It’s acquired through skin-to-skin contact with anyone, including sexual partners (especially if it’s hot and sweaty). It’s even found on pets. Staph becomes dangerous if it gets under the skin through routes such as cuts or abrasions.

Don’t give this one a chance

• Wash your hands with soap frequently, and shower regularly
• Moisturize to avoid dry and cracked skin—an easy entry for the bug
• Treat all wounds with an iodine-based antibacterial rub (e.g. Betadine) and keep covered
• At saunas and other SOPVs and the gym, sit on your towel, wear protective footwear and shower frequently>/li>
• Don’t share towels and razors
• Don’t try to drain your own abscesses
• Only take antibiotics when absolutely necessary and then as prescribed: complete the course
• Use condoms, and if sero-sorting with other PLHIV recognise that there is a risk of CA-MRSA in every encounter (see below for tell-tale symptoms)

How to recognize it

Staph infections often begin as a red lesion or bump resembling a spider bite. It can be itchy or painful and grow quickly. It might come to a head like a pimple, but with more pain and pressure.

What to do

• Head straight to your doctor to have the sore or abscess examined (regardless of where it is) and drained if necessary. Don’t imagine it will go away because it won’t.
• Your doctor can start you on antibiotics while the lab checks to confirm what kind of bug you have. Since many staph infections are now MRSA, the best course of treatment is an immediate prescription of antibiotics capable of overcoming resistant cases.
• Make sure that you finish your course of antibiotics. As we’ve seen above: CA-MRSA can recur.

Bugs are everywhere: all over our skin, and internally: if we’re living with HIV we have to trust our immune systems to do their job. Don’t panic! Stick with your HIV meds (if you are on them). An intact immune system is the best way to avoid all of these otherwise nasty bugs.

More information:

On the flu:

(http://www.racgp.org.au/Content/NavigationMenu/About/Healthalerts/201003...).

Your local AIDS Council or PLHIV organisation will be able to provide more information on other things you can do to avoid being infected with the coming season’s flu virusesA small infective organism which is incapable of reproducing outside a host cell.. The ACON website provides a useful summary: http://www.acon.org.au/hiv/news/flu-vaccine.

On CA-MRSA:

http://www.public.health.wa.gov.au/3/896/3/camrsa.pm

http://www.theaustralian.com.au/news/health-science/superbugs-lead-infec...

1. 1. Sogaard OS et al. (2008) Hospitalization for pneumonia among individuals with and without HIV infection, 1995-2007: a Danish population-based, nationwide cohortIn epidemiology, a group of individuals with some characteristics in common. A cohort study is a special kind of clinical trial which looks at a treatment or treatment strategy in a cohort of people. study. Clin Infect Dis. 2008 Nov 15;47(10):1345-53.
2. 2. Diep BA et al. (2008) Emergence of multidrug-resistant, community-associated, methicillin-resistant Staphylococcus aureus clone USA300 in men who have sex with men. Ann Intern Med. 2008 Feb 19;148(4):249-57.
3. 3. Popovich KJ et al. (2010) Community-associated methicillin-resistant Staphylococcus aureus and HIV: intersecting epidemics. Clin Infect Dis. 2010 Apr 1;50(7):979-87.
4. 4. Crum-Cianflone N, Weekes J, Bavaro M. (2009) Recurrent community-associated methicillin-resistant Staphylococcus aureus infections among HIV-infected persons: incidence and risk factors. AIDS Patient Care STDS. 2009 Jul;23(7):499-502.