HIV and COVID-19 coinfection: case reports, retrospective cohorts and outcomes
Simon Collins, HIV i-Base
In the last few weeks several new studies have reported on larger cohorts of HIV positive people with COVID-19 coinfection.
Data are still limited and hopefully larger national cohorts will be reported soon with more details on people living with HIV. There is also clearly a role for independent researchers to run meta-analyses from larger data sets.
Studies so far include from China, Germany, Italy, Spain, the UK and the US and are summarised in Table 1. [1 – 16]
This table will be added to as new data becomes available. Although other small case studies (n=1 to 4), have been reported and are referenced but as these add little to larger cohorts they are not included in the table. [17 – 20]
The most recent publications are:
A UK study describing 18 HIV positive people with COVID-19 at Kings College, South London. Most (17/18) were black, on long-term ART and undetectable but comorbidities were common. Five have died and one is still in hospital. 
A Spanish study of 51/2873 (1.8%) HIV positive people diagnosed with COVID-19 at a single hospital in Madrid. Six were critically ill and two have died. 
A case series of nine HIV positive people diagnosed with COVID-19 at a single centre in the South Bronx. All had comorbidities and 7/9 died (78%). 
An Italian study describes 47 HIV positive people referred to a single hospital between 21 February and 16 April 2020 with proven/probable COVID-19. Of these 45/47 (96%) fully recovered and two died. 
A German study on 33 HIV positive people, previously referred to in the joint BHIVA/EACS statement has also now been published in full. 
Generally, at least in statements by BHIVA and EACS, this is being taken as evidence that people on effective ART are not at any higher risk than the general population. 
However, the difficulties of interpreting outcomes in these small studies – whether different or similar to the general population – was also highlighted by UK researchers in correspondence to Lancet HIV. 
As larger studies become available, we will add them to this table.
Table 1: Studies reporting HIV/COVID-19 coinfection
|Childs K et al.||Case series of 18 people (12 men, 6 women) with HIV and COVID-19 being treated at Kings College Hospital in South London. Median age was 52 years (IGR: 49 to 58). 17/18 were Black race. Median time since HIV diagnosis was 14 years (IQRL 10 to 23 years). All were on ART, with 17/18 having undetectable viral load. Latest CD4 count was median 395 cells/mm3 (IQR: 238 to 680) but median CD4 nadir was only 97 cells/mm3 (IQR: 45 to 143). Comorbidities were common, with 10/18 having BMI >30kg/m2, 6/18 had hypertension, 4/18 had diabetes and 5/18 had chronic kidney disease. 12 pts were successfully discharged, one is still hospitalised and five died (median 5 days since admission (range: 3 to 28). Compared to our whole HIV cohort those hospitalised with COVID-19 were more likely to be of black ethnicity (OR 12.22 [95%CI: 1.62-92.00]) and to have lower CD4 count (395 vs. 573, p=0.03).||18 HIV+, 17/18 black.
|Vizcarra P et al.||Prospective, observational study of 51 people consecutively diagnosed with COVID-19 (8 women, 43 men) from a single HIV centre in Madrid from cohort of 2873 pts (incidence 1·8%, 95%CI: 1.3 to 2.3). 35/51 were lab confirmed and 28/51 were hospitalised. Age (range 31 to 75) and CD4 was similar to those without COVID-19 but 63% vs 38% had at least one comorbidity (mainly hypertension and diabetes). 6/51 (12%) were critically ill and two died.||51/2873 (1.8%), 2/51 died.||2|
|Suwanwongse K et al.||Case series of nine patients (seven men, two women) hospitalised with COVID-19 at a single centre in the South Bronx, New York from 25 March to 30 April 2020. Median age was 58 years (range: 30 to 76). All patients had comorbidities. CD4 count ranged from 179 to 1827 cells/mm3. HIV viral load was <50 copies/mL is all (but unknown in one). Only 8/9 were on ART, which was discontinued for 4/8 (2 for kidney complications. 7/9 patients died (78%) Seven patients died (78%), four due to hypoxemic respiratory failure and three from septic shock and multi-organ failures.||
7/9 died (78%).
|Gervasoni C et al.||Retrospective Italian cohort from single hospital site in Milan from 21 February and 20 April 2020. 47/6000 HIV positive people identified. Mean age 51 (+/–11,) 36 men, 11 women. 28/47 were hospitalised. 45/47 recovered and 2/47 died. Minimal treatment but remdesivir + tocilizumab in one and tocilizumab alone in one.||47 HIV+, 2/47 died||4|
|Härter G et al.||Retrospective German cohort from 12 sites. 29/32 (91%) have recovered and 3/32 died. Mean age was 48 years (range 26–82 years) and 30/33 patients were men. Median CD4 was 670 cells/mm3 (range 69 to 1715). Although this study reported increased hospitalisation and mortality for HIV positive people, this might be due to other factors. Mechanical ventilation needed by two people with detectable HIV viraemia.||33 HIV+.
|Guo et al.||Subset of 1178/6000 HIV positive people in Wuhan City who were contacted by telephone. 8/1178 who self-reported symptoms were later confirmed with COVID-19 (0.68%). 6/8 were mild, 1/8 was severe and 1/8 died. Only 1/9 HIV positive people in close household contact with COVID-19 became coinfected with COVID-19 (late diagnosed with CD4: 27 cells/mm3).||8/1178 HIV (0.68%) positive people were coinfected with COVID-19.||6|
|Karmen-Tuohy S et al.||Case-control study in NYC matching 21 HIV positive people to 42 HIV negative people reporting similar outcomes in both groups – and that HIV doesn’t impact this.||21 HIV+ and 42 HIV – controls.||7|
|Richardson S et al.||Characteristics, symptoms, and outcomes of 5700 patients hospitalised with COVID-19 in 12 hospitals in outer NYC boroughs between 1 March and 4 April 2020. Although no clinical details were presented separately for the 43 people (0.8%) who also had HIV positive status recorded, it provided an indication that HIV might not be over-represented.||43/5700 (0.8%) were HIV positive.||8|
|ISARIC reports.||ISARIC published paper and online COVID-19 report (27 April 2020). The published paper on general population includes >20,000 people with COVID-19 (approximately one-third of almost 60,000 people hospitalised. Median age was 72 years [IQR 57, 82; range 0, 104]. Of 17,168 with HIV data, 83 (55 M, 28W) were HIV positive (0.5%).||At least 120 HIV positive people in the UK have been diagnosed with COVID-19, with > 40 deaths.||9, 10, 11|
|Goyal P et al.||Characteristics and outcomes of first 393 consecutive patients with COVID-19 hospitalised at a single community hospital in NYC. No clinical details were presented for the 7/393 who were also HIV positive.||7/393 were HIV positive.||12|
|Blanco JL et al.||Characteristics and outcomes of first 543 consecutive patients with COVID-19 hospitalised at a single community hospital in Barcelona. Clinical details for the 5/543 (0.92%) who were also HIV positive included ART, risk factors and outcomes. 1/5 was diagnosed as a late presenter with CD4: 11 cells/mm3. All since discharged.||5/543 (0.92%) were HIV positive||13|
|Miro JM et al.||Updated numbers to the Spanish cohort above (Blanco et al) reported in correspondence, included 42 HIV/COVID-19 coinfections. 32/42 were hospitalised including one new HIV diagnosis. This was 42/5649 (0.7%) of the HIV cohort, 1·9% of the 2215 emergency department visits for COVID-19 and 1·5% of the 2102 hospital clinic admissions.||32/2102 hospitalised were coinfected. Approx. 0.7% of HIV cohort reported COVID-19.||14|
|Riva D et al.||Three case studies of COVID-19 coinfection in HIV positive people on darunavir-based ART.||3 case studies.||15|
|Zhao J et al.||38-year-old Chinese gay man diagnosed with COVID-19 on 25 January who had travelled to Wuhan several weeks earlier. He had been diagnosed with HIV in 2016 with a CD4 count of 84 cells/mm3 and HCV coinfection.||Single case study, included earlier HCV coinfection.||16|
We will continue to add new publications to this Table as they become available.
STOP PRESS: Two additional papers were published in between publication and distribution of this issue, that will be reviewed in the next issue of HIV and COVID-19. [23, 24]
- Childs K et al. Hospitalised patients with COVID-19 and HIV: a case series. Clinical Infectious Diseases, ciaa657, DOI: 10.1093/cid/ciaa657 (27 May 2020)
- Vizcarra P et al. Description of COVID-19 in HIV-infected individuals: a single-centre, prospective cohort. The Lancet. DOI: 10.1016/S2352-3018(20)30164-8. (28 May 2020).
- Suwanwongse K et al. Clinical features and outcome of HIV/SARS‐CoV‐2 co‐infected patients in the Bronx, New York City. Jour Med Vir. DOI: 10.1002/jmv.26077. (28 May 2020).
- Gervasoni C et al. Clinical features and outcomes of HIV patients with coronavirus disease 2019. Clinical Infectious Diseases, ciaa579, DOI: 10.1093/cid/ciaa579/ (14 May 2020).
- Härter G et al. COVID-19 in people living with human immunodeficiency virus: a case series of 33 patients. Infection. DOI: 10.1007/s15010-020-01438-z. (11 May 2020).
- Guo W et al . A survey for COVID-19 among HIV/AIDS patients in two districts of Wuhan China. Lancet. DOI: 10.2139/ssrn.3550029 (13 March 2020).
- Karmen-Tuohy S et al. Outcomes among HIV-positive patients hospitalised with COVID-19. Ahead of peer review.
- 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).
- Docherty AB et al. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ 2020; 369:m1985. doi: 10.1136/bmj.m1985. (22 May 2020).
- ISARIC Clinical data COVID-19 report (27 April 2020).
- Personal communication.
- Goyal P et al. Clinical Characteristics of Covid-19 in New York City. NEJM. DOI: 10.1056/NEJMc2010419. (17 April 2020).
- Blanco JL et al. COVID-19 in patients with HIV: clinical case series. Lancet HIV. Correspondence. DOI: 10.1016/S2352-3018(20)30111-9. (15 April 2020).
- Miro JM et al. COVID-19 in patients with HIV. Lancet HIV, Correspondence. (14 May 2020).
- Riva D et al. Darunavir does not prevent SARS-CoV-2 infection in HIV patients. Pharmacological Research (157), 104826 (20 April 2020).
- Zhao J et al. Early virus clearance and delayed antibody response in a case of COVID-19 with a history of co-infection with HIV-1 and HCV. Clinical Infectious Diseases, ciaa408, DOI: 10.1093/cid/ciaa408. (09 April 2020).
- Wu Q et al. Recovery from COVID-19 in two patients with coexisted HIV infection. J Med Virol. DOI: 10.1002/jmv.26006. (13 May 2020).
- Patel RH et al COVID‐19 in a patient with HIV infection. J Med Vir. (22 May 2020).
- Baluku JB et al. HIV and SARS-CoV-2 Co-Infection: A Case Report From Uganda. J Med Virol DOI: 10.1002/jmv.26044. (21 May 2020).
- Aydin OA et al. HIV/SARS-CoV-2 co-infected patients in Istanbul, Turkey. J Med Virol. DOI: 10.1002/jmv.25955. (29 April 2020)
- BHIVA, DAIG, EACS, GESIDA & Polish Scientific AIDS Society Statement on risk of COVID-19 for people living with HIV (PLWH). (25 May 2020).
- Jones R et al. COVID-19 in patients with HIV. The Lancet HIV (14 May 2020).
Okoh AK et al. COVID-19 pneumonia in patients with HIV – a case series. JAIDS. Letter. doi: 10.1097/QAI.0000000000002411. (28 May 2020).
Ridgway JS et al. A case series of five people living with HIV hospitalized with COVID-19 in Chicago, Illinois. AIDS Patient Care and STDs. DOI: 10.1089/apc.2020.0103. (29 May 2020).