The high-dose influenza vaccine (HDIV) demonstrated a 50% reduction in influenza-like illness (ILI) compared with the standard dose in HIV-infected patients, according to research presented atIDWeek, held virtually from October 21 to 25, 2020.

In a retrospective cohort study, conducted at the University of Kansas Medical Center, included 219 patients with HIV during the 2017-2018 influenza season. The median age was 53 years and 197 patients (89.9%) were men. Within the cohort, 13.7% had a HIV viral load greater than 40 copies/mL and 5% had CD4 count less than 200 cells/µL. HDIV and standard dose influenza vaccines (SDIV) were administered to 119 patients (54.3%) and 77 patients (35.2%), respectively, and 23 patients (10.5%) were unvaccinated.

A modified CDC definition of ILI, defined as fever and cough, sore throat, or shortness of breath occurred in 8 patients (10.4%) in the SDIV group compared with 6 patients (5.0%) in the HDIV group (P =.16). A broader protocol-defined ILI, defined as sore throat, cough, or shortness of breath with either fever, chills, headache, or myalgia was reported in 16 patients (20.8%) and 12 patients (10.1%) of the SDIV and HDIV groups, respectively (P =.04). There was no difference in confirmed influenza cases between groups. Vaccine side effects were mild, occurring in 11 patients (14.3%) in the SDIV group compared with 13 patients (10.9%) in the HDIV group (P =.5). Vaccine dose (SDIV odds ratio [OR], 2.34; 95% CI, 1.04-5.37; P =.04) and age in years (OR, 0.97; 95% CI, 0.94-1.0; P =.045) were associated with protocol-defined ILI. HDIV remained protective regardless of age.

The CDC reported an influenza attack rate of 14.7% in US adults and an overall vaccine effectiveness of 38% for the 2017-2018 influenza season. This study “demonstrated a 50% relative reduction in protocol-defined ILI with the HDIV compared [with] standard-dose vaccine our HIV clinic in 2017-2018,” study authors concluded. Investigators, therefore, recommended a larger prospective randomized control trial on the effectiveness of the HDIV in HIV patients.

Disclosure: One study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of author’s disclosures.

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Acombination of flu and HIV medications may be able to treat severe cases of 2019-nCoV, the new coronavirus that has emerged in China, according to doctors in Thailand who have been caring for infected patients. The team’s approach, which used large doses of the flu drug oseltamivir combined with HIV drugs lopinavir and ritonavir, improved the conditions of several patients at the Rajavithi Hospital in Bangkok.

“This is not the cure, but the patient’s condition has vastly improved,” Rajavithi Hospital’s Kriangsak Atipornwanich says of one 70-year-old Chinese woman from Wuhan, according to Reuters. “From testing positive for 10 days under our care, after applying this combination of medicine the test result became negative within 48 hours.”

Thailand has so far recorded 19 cases of coronavirus, Reuters reports, making it the country with the greatest number of infections in Southeast Asia. Eight patients have recovered, while the rest are still undergoing treatment. Officials say that the country’s health ministry would meet today (February 3) to discuss the new treatment for severe cases. “We still have to do more study to determine that this can be a standard treatment,” Atipornwanich tells reporters.

Other countries have also showed interest in using HIV drugs against the new coronavirus. China’s National Health Commission recently began recommending lopinavir and ritonavir (sold together by Illinois-based pharma AbbVie as Kaletra), according to Fierce Pharma. AbbVie has pledged to donate about $1.5 million worth of Kaletra for the effort.

A randomized controlled clinical trial is now underway in China to test the anti-HIV drugs’ efficacy, according to a study published last week (January 24) in The Lancet. Scientists in Hong Kong will also likely test these drugs in patients alongside immune system–boosting medications, Hong Kong University microbiologist Yuen Kwok-Yung tells Science.

Other treatments being considered by national governments and pharma companies include Gilead Sciences’s remdesivir, a drug that was designed to treat Ebola but failed efficacy tests. “Gilead is working closely with global health authorities to respond to the novel coronavirus (2019-nCoV) outbreak through the appropriate experimental use of our investigational compound remdesivir,” the company’s Chief Medical Officer Merdad Parsey says in a statement.

Massachusetts-based Moderna Therapeutics, meanwhile, is collaborating with the US National Institute of Allergy and Infectious Diseases to develop an mRNA vaccine, Fierce Pharma reports.

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They claim that ditching carbs has helped them to target stubborn areas of fat without having to cut out lots of calories.

However, dietitian Robbie Clark has revealed that going keto could actually make you gain weight – if you’re not following the right steps.

And he says that many dieters make some big mistakes which mean their body doesn’t get into a state of “ketosis” and “burn fat for energy instead of glucose”.

Here, Robbie explains common mistakes people make on a keto diet that could be making you fatter…and how to avoid them.

1. Dramatically cutting carbs

Robbie says one of the most common mistakes he finds in terms of clinical practice is that people are reducing their carbohydrate intake “cold turkey.”

“They’ve gone from a diet that is probably consumed moderate or high amounts of carbs to an extremely low amount, and this is a drastic change for the body,” he told.

“This is when they’re at risk of the keto flu.

“The keto flu is the body adapting to the whole process in a large depletion in glucose.

“And the symptoms can include nausea, headaches, fatigue, insomnia, constipation and reduced exercise tolerance.”

Robbie recommends tapering down carb intake instead of reducing the level at an extreme rate.

2. Not drinking enough water

An important thing to do on a keto diet is to keep drinking enough water.

The drastic decrease in carbs can cause shifts in fluids and electrolyte balance.

“The body is washed-out of a lot of fluid especially when losing fat mass as well,” Robbie says.

“The body flushes out the ketones in the urine which also depletes not just water but sodium, an important electrolyte, from the body.”

According to Robbie, this is something that needs to be replaced.

3. Eating the right veg

Vegetables have carbohydrates and for a lot of people, this means watching how much is actually consumed.

If you’re not careful of the types of carbs on the keto diet, the affect is that people won’t stay in that ketosis state.

Robbie says: “On the other hand, the ketogenic diet is a ‘low carbohydrate diet’ and not a ‘no carbohydrate diet’.

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Fans of the keto diet love to tout the regimen’s merits for building muscle and burning fatOpens in a new Window., but new research shows it could give your immune system a boost, too. Researchers at Yale University recently published a studyOpens in a new Window. in Science Immunology showing that a high-fat, low-carb keto diet helped mice more effectively fight off the influenza virusOpens in a new Window., and the data has strong implications for humans, too.

In humans, a keto diet usually revolves around eating fish, meat, poultry, and non-starchy fruits and vegetables to achieve a high-fat, low-carb ratio. The researchers fed mice a similar diet (in terms of macronutrients), then exposed them to the influenza virus. They found that mice on the keto regimen had a higher survival rate than those on a regular diet. Further investigation revealed that the keto mice had activated a specific kind of T cellOpens in a new Window., a white blood cell that forms an integral part of the immune response in mice and humans. This specific T cell, called a gamma T cell, appeared in the lungs of the mice, where it stimulated mucus production that effectively trapped and neutralized the influenza virus. According to a Yale University blog postOpens in a new Window., this is the first time that gamma T cells have been linked to an immune response to the flu.

“This was a totally unexpected finding,” said co-senior author Akiko Iwasaki.

The researchers also performed experiments to narrow down exactly what caused the mice to fight off the flu so effectively. They tried feeding another group of mice a high-fat, high-carb diet, but those animals didn’t produce gamma T cells. Directly introducing a chemical ketone (the metabolic byproduct of burning fat) without altering the mice’s diet also failed to activate gamma T cells. Finally, the researchers put mice that had been bred without the gene to make gamma T cells on a keto diet, but they didn’t show the desired immune response, either.

Based on those experiments, the researchers concluded that a keto diet triggers a unique type of immune boost—one that could be a big factor in fighting off the flu this season.

“This study shows that the way the body burns fat to produce ketone bodies from the food we eat,” said co-senior author Vishwa Deep Dixit, “can fuel the immune system to fight flu infection.”

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Ditching carbohydrates and eating lots of fat may give some protection against the flu. Feeding mice the so-called keto diet seems to boost certain immune cells, which may be responsible for the effect.

The keto diet forces the body to burn fat for energy, which can help with weight loss, and people may get flu-like symptoms known as the “keto flu” as their body adapts to so little carbohydrate. The keto diet has also been linked to improved heart health and control of blood sugar in diabetes, but much of the evidence is conflicting.

Akiko Iwasaki at Yale School of Medicine and colleagues previously found that the keto diet reduced inflammation in mice with gout. Because inflammation is common to both gout and flu, the team thought the keto diet could similarly deal with flu-related inflammation, which can severely damage the lungs.

To put this theory to the test, the team fed mice infected with influenza A – the most serious type of the virus – either a keto or standard diet for a week before infection. After four days, all seven of the mice fed a standard diet succumbed to the infection, compared to only five out of the 10 mice on the keto diet. These keto diet mice also didn’t lose as much weight, which is usually a clear sign of flu infection in animals.

The team found that the keto diet amped up the numbers of a specific type of T cell – key players in the body’s immune response – found in the lungs. Boosting these T cells dampened the sensitivity of cells lining the lungs to infection and increased mucus production.

It seems that this extra mucus is important for protecting the mice, says Iwasaki, because it traps the flu virus to stop it spreading. It still isn’t clear what these T cells do outside of this study though, she says.

Although mouse and human metabolisms differ, the finding could mean that people get a similar protection from influenza when on the keto diet.

“We already knew of a link between diet and immunity,” says John Tregoning at Imperial College London, who wasn’t involved in the work. Eating foods rich in vitamin C, for example, is known to strengthen our immune system. Switching to a keto diet may help boost the immune system so that it is better programmed to fight off the infection, says Tregoning.

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LONDON, Sept 3 — New European research has found that individuals with high blood pressure could lower their risk of death during flu season by getting the influenza vaccine.

Carried out by researchers at the University of Copenhagen, Denmark, the new study looked at 608,452 patients aged 18 to 100 years with hypertension (high blood pressure) during nine consecutive flu seasons.

The researchers recorded how many patients had received a flu vaccine before the start of each flu season and then followed them through the season, noting how many died from all causes, from any cardiovascular cause, and from heart attack or stroke.

The findings, presented on Sunday at ESC (European Society of Cardiology) Congress 2019 together with the World Congress of Cardiology, showed that after taking into account potentially influencing factors such as age, medications, and socioeconomic status, high blood pressure patients who received the flu vaccine appeared to benefit from an 18 percent reduced risk of death from all causes during flu season.

In addition, those who received the vaccine had a 16 per cent reduced risk of death from any cardiovascular cause, and a 10 per cent reduced risk of dying from heart attack or stroke.

“Given these results, it is my belief that all patients with high blood pressure should have an annual flu vaccination,” commented first author Daniel Modin. “Vaccination is safe, cheap, readily available, and decreases influenza infection. On top of that, our study suggests that it could also protect against fatal heart attacks and strokes, and deaths from other causes.”

Previous research has suggested that the stress the flu infection puts on the body could trigger heart attacks and strokes, with Modin adding that the strong immune response to the infection can also cause inflammation which could lead to heart attacks and strokes.

“Heart attacks and strokes are caused by the rupture of atherosclerotic plaques in the arteries leading to the heart or the brain. After a rupture, a blood clot forms and cuts off the blood supply. It is thought that the high levels of acute inflammation induced by influenza infection reduce the stability of plaques and make them more likely to rupture,” explained Modin.

Those with high blood pressure already have a higher risk of heart attack and stroke, and so preventing a flu infection through vaccination may help to protect against cardiovascular events.

“We show that influenza vaccination may improve cardiovascular outcomes in patients with hypertension. During the nine flu seasons we studied, vaccine coverage ranged from 26 per cent to 36 per cent, meaning that many patients with high blood pressure were not vaccinated. If you have high blood pressure, it would be worth discussing vaccination with your doctor,” advised Modin. — AFP-Relaxnews

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