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Influenza immunisation: knowledge and actions taken by UK HIV‐positive adults

Influenza is an important cause of respiratory illness in the general population and is responsible for exacerbations of pre-existing respiratory disease (which are more common in people living with HIV) [1,2]. Current evidence suggests that individuals with HIV who are not using antiretroviral therapy (ART) have a higher rate of complications associated with influenza and an increased duration and severity of illness – although the extent to which ART reduces this is uncertain [3,4]. The Trivalent Inactivated Influenza Vaccine (TIV) appears effective in preventing influenza in individuals with HIV [5]. It is recommended for all HIV-positive patients in the UK with a target of 95% coverage [6] although uptake may be suboptimal [7–15]. There are limited data regarding rates of immunisation in the UK HIV-positive population, or the health beliefs concerning influenza immunisation which may influence its uptake. Here we report data from a large metropolitan HIV service regarding the use and health beliefs surrounding influenza immunisation in people living with HIV infection. We conducted a cross-sectional study of HIV-positive adults presenting for routine care at a large urban HIV care service in London, UK, between September and December 2014. Individuals attending clinic appointments within the ambulatory care service during the study period were invited to complete an anonymous questionnaire detailing demographics, ART use, influenza immunisation in the previous year and intentions regarding immunisation in the 2014–2015 season. For those who had not been vaccinated, the reasons underlying this decision were sought. Questions explored each participant’s knowledge regarding the efficacy of the influenza vaccine and the clinical course of influenza in HIV-infected individuals. Two hundred and fifty-three individuals completed the questionnaire between October and December 2014: 195 participants were male (83% of those reporting their gender), 39 female and 19 did not state their gender; 177 (70%) were White, 47 (18.6%) Black African or Black Caribbean and 89% were using ART. The median age of study participants was in the 55–64 age category compared to a median age in the total clinic population of 47 years (interquartile range, 41–53 years). One hundred and sixty-three respondents [64%; 95% confidence interval (CI) 58–70%] had or planned to have an influenza immunisation in 2014–2015 and 171 participants (68%; CI 61–73%) recalled immunisation in 2013– 2014. Of these, 68 (40%) reported that immunisation was given in GP practices and 56 (33%) in HIV care services, with the remainder provided by pharmacies, supermarkets and workplaces. Immunisation rates were lower in younger patients, with 157 of 223 (70%) above the age of 45 years reporting immunisation in the 2013–2014 season compared to 14 of 30 (47%) younger participants (P = 0.018, vtest). Immunisation rates were greater in women: 34 of 39 women (87%) reported immunisation compared to 65% of men (127 of 195, P = 0.025). There was no significant difference between White and NonWhite ethnic groups. The use of ART was associated with a higher rate of immunisation uptake (70% vs. 43% P = 0.01), although only 21 participants were not using ART. Amongst 65 participants stating that they had not been immunised in 2013–2014, reasons given were as follows: 16 (25%) did not think that they needed immunisation, 15 (23%) reported concern about adverse events and 14 Correspondence: Marc Lipman, Centre for Respiratory Medicine, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK. Tel: + 44 207 317 7560; fax: +44 207 317 7561; e-mail: marclipman@nhs.net