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Zovirax suspension rezeptfrei was reported to reduce the duration of illness symptoms, even in those with prior experience of severe illness or who had a high viral load (8). In one trial, antiviral drug treatment was found to be as effective placebo (5). Pitfalls in clinical practice: the case of HIV-related severe flu illness A recent study demonstrated that even though more than half of HIV-positive adults and children have a viral load ≥100 copies/mL, they are still at risk of severe influenza-like illness (2). The influenza vaccination program in United States includes a large proportion of persons with a high viral load (2). Thus, as long these persons are not receiving antiviral therapy (antiretroviral drugs are used to treat HIV infection), they are at high risk for severe infections. (Because antiviral therapy is contraindicated in HIV infection, patients taking antiviral drugs do not need influenza vaccines.) The results reported in this study strongly suggests that antiviral drugs do not have value in reducing the severity of severe symptoms. This effect occurs, in part, because some patients develop severe influenza with their first infection. In addition, HIV-positive patients taking antiviral drugs have been reported to experience other serious adverse events, including the following: severe dehydration (4), irrational thoughts (6), and acute gastrointestinal upset (6,15). It is important to emphasize that although antiviral drugs are not necessary to avoid illness associated with influenza, many HIV-positive persons cannot take antiviral medications without compromising their
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ability to control disease. Therefore, they should limit their exposure to a pandemic influenza outbreak when it occurs. Top of Page Conclusion Because HIV infection is associated with influenza virus infection, both during the current epidemic and throughout years before it, HIV-infected persons who are at risk for severe infection of the lung should be especially careful about influenza vaccination when they are hospitalized. Therefore, all HIV-positive persons
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receiving antiviral agents for their infection or treatment of HIV and all other persons with
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high viral loads should receive influenza vaccine (see recommendation 2.1). It is of increasing importance to disseminate this recommendation. References Paz P, Lai S, Lin J, et al. Effectiveness of antiviral therapy for HIV infection. JAMA. 2005;294:1564-63. [PubMed abstract] Lischky J, Schauer Schramm M, et al. The response
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to highly active antiretroviral therapy and influenza. AIDS. 2006;22:2383-9. [PubMed abstract] Schramm M. Influenza-associated acute respiratory distress syndrome among HIV-infected adults with clinical or virologic response. Clin Infect Dis. 1999;29:1398-402.
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