HTB

HIV is not linked to higher risk of COVID-19 in large New York cohort

Simon Collins, HIV i-Base

Several papers have recently been published that include HIV status of people hospitalised with COVID-19.

The largest of these, published as an open access paper in JAMA, includes 5700 people hospitalised in the wider New York area between 1 March and 4 April 2020, where 43 people were also recorded as being HIV positive (0.8%). [1]

This is a comprehensive dataset for demographics, comorbidities, home medications, symptoms, laboratory tests, electrocardiogram results and treatments. Clinical outcomes (including length of stay, discharge, readmission, and mortality) are presented for 2634/5700 patients who completed their hospital course at study end (discharged alive or dead). Please see the full paper for details (especially for details on hypertension and ACE inhibitors).

The population covered by the hospitals includes approximately 11.3 million people in the New York metropolitan, where approximately 100,000 people are HIV positive (1%).

Although the study doesn’t include multivariate analyses for risk factors, the results are perhaps the most optimistic dataset to support HIV itself not being a risk factor for COVID-19.

Two other papers included smaller retrospective cohorts of just under 400 people. One is also from New York and one from Barcelona, which reported seven and five people respectively who were also HIV positive. [2, 3]

This HTB article was first published online on 22 April 2020.

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These results should be slightly reassuring for HIV positive people, although many of us also have other risk factors for COVID-19 that are common. However, the hospitals in this area are not the inner city clinics that are more commonly attended by people who are HIV positive.

Hopefully, as the largest cohort of HIV/COVID-19 coinfection so far, the researchers of this JAMA study could report characteristics of people with HIV coinfection.

In the UK, it is also important that HIV status is included for all people hospitalised with COVID-19. [4]

Anecdotal reports of 13 people diagnosed with COVID-19 at a central London clinic included 13 who are also HIV positive. Approximately half of these people were on ART that contained TDF/FTC, showing that HIV PrEP is not effective at preventing COVID-19. [5]

The data on ART use in these cohorts could perhaps inform an ongoing study for coronavirus prophylaxis in health workers that is proposing to study TDF/FTC as prophylaxis for COVID-19. [6]

References

  1. Richardson S et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City Area. JAMA. doi:10.1001/jama.2020.6775. (22 April 2020).
    https://jamanetwork.com/journals/jama/fullarticle/2765184
  2. Goyal P et al. Clinical Characteristics of Covid-19 in New York City. NEJM. DOI: 10.1056/NEJMc2010419. (17 April 2020).
    https://www.nejm.org/doi/full/10.1056/NEJMc2010419
  3. Case series of five HIV positive people diagnosed with COVID-19 in Spain. HTB (17 April 2020).
    http://i-base.info/htb/37661
  4. Why it is important to include HIV status and HIV testing in managing COVID-19. HTB (17 April 2020).
    http://i-base.info/htb/37588
  5. Personal communication.
  6. COVID-19 prophylaxis using TDF/FTC and low-dose hydroxychloroquine in Spanish health workers. HTB (17 April 2020).
    http://i-base.info/htb/37625

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