HIV/AIDS & H1N1: plain language symptoms & treatment from dr. peter ruane (0061)

Peter_RuaneMessage from Dr. Peter Ruane Re: H1N1 and HIV
monday, oct 26
(thanks to the heads-up from sunnie rose —rk)

Please do not reply to this. But feel free to forward it to friends etc. —Peter

I am getting more calls than usual from patients who have the flu. Based on this and the public health information, you should be ready to deal with coming down with flu.

This is intended as a focused update on the influenza outbreak and advice to my patients as it applies at this time. Please be aware that this is not intended to be a substitute for medical care and the advice can change. There is a wealth of information on the CDC.gov website for more specific questions.

h1n1_n
There are 2 parts to this:

Early recognition / Treatment.

Vaccination

H1N1: This is not your friend….

For a formal review that is easy to read: http://www.cdc.gov/h1n1flu/qa.htm

Remember: you should have a thermometer. If you don’t have one, stop off and buy one today.

How to Diagnose yourself and Efficiently Get Treatment for Acute Influenza

Early recognition is important as the sooner you recognize that you have it, the sooner we can get treatment started for you (see below).
This is from the CDC website: The symptoms of 2009 H1N1 flu virus in people include

  • fever,
  • cough,
  • sore throat,
  • runny or stuffy nose,
  • body aches,
  • headache,
  • chills and
  • fatigue.

Some people may have

  • vomiting and
  • diarrhea.

People may be infected with the flu, including 2009 H1N1 and have respiratory symptoms without a fever.

I would add: look for rapid onset, as in:

“ Hey Doc, this morning I felt fine, 4 hours ago I started to get body aches and now I feeling worse by the hour…”

Or

“Yesterday I thought I had a cold but I feel awful today, coughing and aches all over, maybe fever.”

That kind of rapid progression with the above symptoms suggests flu to me.

Treating Acute Flu:

There is very effective treatment for acute influenza H1N1. The virus remains sensitive to Tamiflu and this drug is very effective if used promptly. It is taken 75 mg twice daily for 5 days. Once it looks like you have flu, you should start it ASAP. They say starting less than 12 hours after you start to come down is best but that the drug is still very effective out to 48 hours. After 48 hours, it is less clearly effective but would still likely be beneficial and I would prescribe it for you. Timing in all this is critical.

Although anyone can get sick from H1N1 influenza. It can not be assumed that you will get very sick. Many people may only have a mild illness. But if it feels severe at the outset and accelerates, it may mean that you will be sicker than most. http://www.cdc.gov/h1n1flu/sick.htm

People who are likely to get sickest are as follows: These underlying conditions include

  • asthma,
  • diabetes,
  • suppressed immune systems ( HIV, tumors, chemo),
  • heart disease,
  • kidney disease,
  • neurocognitive and
  • neuromuscular disorders and
  • pregnancy.
  • People > 65 years old may have protective antibodies from flu many years ago but if they don’t, they are also in a high risk. The CDC believes only 1/3 of older people have those antibodies.

I would add that people with HIV, especially those with lower T cells ( especially < 200 ) or who have been < 200 in the past are more likely to be sicker.

So, if you think you are coming down with flu, please call me as soon as possible and be ready to:

  1. Tell me your symptoms. We will sort out if this is flu or not on the phone, and whether you need treatment for flu.
  2. Have already verified with the pharmacy of your choice that they have Tamiflu in stock.
  3. Have ready the telephone number and fax number of the pharmacy so we can call it/fax it in quickly.

If you are calling during office hours, press “0” and tell the Front Desk that you may have flu. The front desk is instructed to handle these calls separately and bring them to the attention of the doctor quickly. If you don’t hear back within an hour, call again.

2 other important points:

If you are at high risk and are travelling, you may wish to bring a dose or two with you on the plane to get it started while you get a full course locally. If you are travelling abroad you may wish to take the full course with you.
If you are significantly exposed to someone with flu, Tamiflu can be used as a prophylactic drug, 75 mg daily for 10 days although we don’t know how effective it is. You should discuss this with me or the covering doctor.

For good general information on what to do if you are sick, whether you may need to go to the ER, how long you need to stay out of work etc: http://www.cdc.gov/h1n1flu/sick.htm

Vaccination:

I recommend the injected vaccine to everyone, but especially those people at higher risk (http://www.cdc.gov/h1n1flu/sick.htm) . It is as safe as the regular seasonal flu vaccine and manufactured by the same process using chicken eggs and without adjuvants. These steps slowed down the manufacturing but ensures its safety. I would advise you receive it.

The vaccine is being made available very slowly but it is likely to be widely available by the middle of November. We do not anticipate receiving much if any before mid-November. If you are in a high risk group ( and especially a very high risk group eg HIV with low T-cells < 200, or HIV with other problems ( transplants, other drugs that hit the immune system, bad lung disease etc) and you can access it before we can get it, please go ahead. The vaccine is provided free but there is an administration fee that may vary.

As soon as we have the vaccine in, we will place a message on the office voice mail with instructions and send out another e-mail.

General advice:

I HIGHLY advise recommend you become familiar with this: http://www.cdc.gov/h1n1flu/qa.htm It explains how to avoid infection in a variety of circumstances.

Hope this helps!

Peter

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