Swine flu: dealing with infection

What is H1N1 (swine flu)?

H1N1 is a new strain of the influenza virus, commonly known as swine flu.

It has spread quickly because it is a new type of flu virus that few, if any, people have full resistance to. Unlike seasonal flu, children and young adults are at higher risk than older people (over 65) of getting swine flu, as are those with some underlying conditions.

In most cases the virus has proved relatively mild. However, some people have become more seriously ill and some have died, including some previously healthy people. The most common complications have been bacterial chest infections such as pneumonias and bronchitis.

It is expected that there will be more cases of swine flu during the winter flu season and it is also possible that the virus will change over time and become stronger.

Swine flu and HIV

There’s little specific information on swine flu and HIV so far. HIV-positive people do not seem to be at higher risk of getting swine flu. However, they are more at risk of having complications if they do get swine flu, particularly if they have a low CD4 cell count (under 200). Having a condition such as asthma or TB as well can increase the risk further, especially as complications are most often chest infections such as bronchitis or pneumonia.

There is more information on avoiding and preparing for swine flu in the factsheet Swine flu: key facts.

What are the symptoms of swine flu?

The symptoms of swine flu are similar to the symptoms of regular seasonal flu. People usually have a fever or high temperature (over 38°C or 100.4°F) and two or more of the following symptoms:

• unusual tiredness
• headache
• runny nose
• sore throat
• shortness of breath or cough
• loss of appetite
• aching muscles
• diarrhoea or vomiting.

Diagnosis is being done based on presence of symptoms rather than on laboratory testing.

What should I do if I think I have swine flu?

Generally (see When should I seek medical help? below for exceptions to this), you should contact the National Pandemic Flu Service (NPFS) on 0800 151 3100 (minicom: 0800 151 3200), or go to http://www.pandemicflu.direct.gov.uk/. The NPFS will assess your symptoms and, if you are diagnosed with swine flu, arrange for you to have access to antiviral drugs (see below). These can be collected by your ‘flu friend’ from a local collection point.

Do not go to your GP, HIV clinic or A&E. You should not go to any planned medical appointments during the time you are ill. You can call your HIV clinic for advice.

General advice is to stay at home and rest (to avoid spreading swine flu as well as to recover), to take paracetamol or another flu or cold remedy and to drink plenty of fluids.

You should stay at home until you are feeling well and no longer infectious – five days after your symptoms start (seven for a child).

When should I seek medical help?

Phone your GP, rather than contacting NPFS, if you have symptoms of swine flu and:

• you have a serious existing illness (this does not include HIV if you have a CD4 count of over 200 and are otherwise well)
• you are pregnant.

Similarly, contact your GP if a child under twelve months shows symptoms of swine flu.

You should also contact your GP or go to A&E if you have swine flu and:

• your condition suddenly gets much worse. Things to look out for include shortness of breath or difficulty breathing; turning blue; chest pain; bloody or coloured sputum; being unusually drowsy or confused; a high fever lasting more than three days; low blood pressure. In children, you should watch out for fast or laboured breathing; lack of alertness; difficulty in waking up and little or no desire to play
• after seven days (five for a child) your condition is still getting worse or fails to respond to antiviral drugs.

Should I take antiviral medication to treat my swine flu?

Swine flu can be treated with the antiviral medicines oseltamavir (Tamiflu) and zanamivir (Relenza). The drugs must be taken at or near the start of the illness to be effective. They are not a cure, but can relieve symptoms, shorten the length of time you are ill and reduce the risk of complications.

At the moment, people with HIV are entitled to receive Tamiflu as a preventive measure. If someone has been in close and prolonged contact with you while you have had symptoms (for example, someone you live with), they may want to take Tamiflu, but they need to do this very soon after exposure. They should contact NPFS for advice and to get a prescription.

Visiting your HIV clinic

If you have symptoms of swine flu, you should not go to any planned medical appointments. It’s also possible that, if the numbers of people with swine flu go up dramatically over the winter, services at HIV clinics may be disrupted – or that you will be advised not to come in because of the risk of becoming infected yourself.

If you are on treatment, you should always make sure you have enough supplies of your anti-HIV drugs to see you through – at least one month’s supply at any time.

There is more information on swine flu on the NHS Choices website at: http://www.nhs.uk/Conditions/Pandemic-flu/Pages/Introduction.aspx

We will be reporting on any new information on swine flu and HIV as it becomes available on aidsmap. Sign up to our email bulletins to be kept informed of new developments.