HTB

Latest studies on HIV/COVID-19 coinfection

Simon Collins, HIV i-Base

The last issue of HTB included a review of approximately 20 published papers on HIV/COVID-19 coinfection. [1]

In the last few weeks another eight papers have been published, from the US, China, and South Africa. [2, 3, 4, 5, 6, 7, 8, 9]

Although many of these are still relatively small cohorts, some report poorer outcomes, likely due to comorbidities and higher risk factors.

The results from South Africa, however, are important for providing the first large cohort from a country with high prevalence of both HIV and TB. The higher mortality from COVID-19 in people living with HIV in this study is controversial and are likely to be explained by issues specific to health care in South Africa. These data are reported in full in a separate article in this issue by Polly Clayden. [10]

Table 1: Recent studies reporting HIV/COVID-19 coinfection

Lead author Notes N Refs
Okoh AK et al. 15 men, 12 women in Newark, New Jersey, US. Median age 58 years (IQR: 50 to 67), 25/27 were African American and 2/27 were Hispanic. Med. CD4 551 (IQR: 286, 710). Common comorbidities included hypertension (59%), diabetes mellitus (33%) and chronic kidney disease (27%). Three required ICU. The two deaths were complicated by septic shock and multi-organ dysfunction. 27 HIV+.

13/27 hospitalised.

2/27 died.

2
Ridgway JS et al. N=5 Chicago, 4 women, 1 man. 4/5 African American. Median age 48 (range 38 to 53). All on effective ART with CD4 >200. 2/5 needed supplemental oxygen, but not mechanical ventilation. All discharged. N=5 HIV+

All survived.

3
Hu Y et al. N=12 (10 men, 2 women) from Wuhan, China. Median age 36 (IQR: 33 to 56; range 25 to 66). All on ART.

Plus 2 men (age 25 and 37) diagnosed with late-stage HIV in hospital.

Cases found using LGBT database and then by telephone contact.

N=14 HIV+ including 2 only diagnosed in hospital.

1/12 died (56 year old man who died at home).

4
Karmen-Tuohy S et al. Case-control study of 21 HIV+ to 42 HIV negative with COVID-19 in NYC, matched for comorbidities. Median age 60. 23% African American.

Reported similar outcomes. 3/21 died. Need larger study.

N=21 HIV+.

3/12 died.

5
Shekhar R et al. Out of 125 patients at centre in New Mexico, only 5/125 (4%) were HIV+ (4 men, 1 woman).  3/5 hospitalised, 2/3 with thromboembolic events. All survived. N=5 HIV+ (4%).

All survived.

6
Calzo L et al. Prospective observational study in 14 HIV+ with COVID-19 (9 men, 5 women) to study immune and viral responses, all on ART (13/14 with undetectable VL). Median age 52. Median CD4 count 612 cells/mm3 (IQR: 339, 886). 9/14 (64%) had one or more comorbidities. All recovered. No ICU admissions and no deaths. 14 HIV+.

No ICU, no deaths.

7
Shalev N et al. Retrospective review of 31 HIV+ from all 2159 adults (1.4%) at single centre for tertiary care in NYC.

Mean age 60 (range, 23–89 years); 24 men and 7 women. Approx 52% non-Hispanic black, 29% Hispanic of any race, and 16) non-Hispanic white. 22/31 (71%) had at least one comorbidity.

Mean CD4 396 (range: 89 to 924). VL <50 in 96%.

8/31 (25.8%) died and 2 (6.5%) were still in ICU. 4/8 were >65 years and 4 were between 50 and 65.

N=31.

8/31 died (25%) with 2 still on ICU at time of analysis.

8
Davies MA et al. South African review of 12,987 COVID-19 cases in the public sector. Of 435 deaths, 52% were associated with diabetes, 12% with HIV, 2% to active TB and 4% to historical TB.

HIV associated with 2-3-fold higher risk of death compared to 13-fold higher with uncontrolled diabetes.

Large public health database of 12,987 COVID-19 cases. 2-3-fold higher mortality associated with HIV.

Likely explained by factors specific to south African setting.

9

This article was first published online on 23 June 2020.

References

  1. Collins S. HIV and COVID-19 coinfection: case reports, retrospective cohorts and outcomes. HTB, HIV/COVID-19 supplement (4). (1 June 2020).
    http://i-base.info/htb/38000
  2. Okoh AK et al. COVID-19 pneumonia in patients with HIV – a case series. JAIDS, ahead of print.Letter. DOI: 10.1097/QAI.0000000000002411. (28 May 2020).
    https://journals.lww.com/jaids/Citation/9000/COVID_19_pneumonia_in_patients_with_HIV___A_Case.96163.aspx
  3. 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).
    https://www.liebertpub.com/doi/10.1089/apc.2020.0103
  4. Hu Y et al. Coinfection with HIV and SARS-CoV-2 in Wuhan, China: a 12-person case series. JAIDS, ahead of print.DOI: 10.1097/QAI.0000000000002424. (12 June 2020).
    https://journals.lww.com/jaids/Abstract/9000/Coinfection_with_HIV_and_SARS_CoV_2_in_Wuhan,.96153.aspx
  5. Karmen-Tuohy S et al. Outcomes among HIV-positive patients hospitalized with COVID-19. JAIDS. DOI: 10.1097/QAI.0000000000002423.
    https://journals.lww.com/jaids/Abstract/9000/Outcomes_among_HIV_positive_patients_hospitalized.96152.aspx
  6. Shekhar R et al. Coronavirus disease of 2019 in patients with well-controlled HIV on Antiretroviral Therapy. JAIDS, ahead of print. DOI: 10.1097/QAI.0000000000002415. (18 June 2020).
    https://journals.lww.com/jaids/Citation/9000/Coronavirus_Disease_of_2019_in_Patients_with.96147.aspx
  7. Calzo L et al. No significant effect of COVID-19 on immunological and virological parameters in patients with HIV-1 infection. JAIDS, ahead of print. DOI: 10.1097/QAI.0000000000002427. (19 June 2020).
    https://journals.lww.com/jaids/Citation/9000/NO_SIGNIFICANT_EFFECT_OF_COVID_19_ON_IMMUNOLOGICAL.96150.aspx
  8. Shalev N et al. Clinical characteristics and outcomes in people living with HIV hospitalized for COVID-19. Clinical Infectious Diseases, ciaa635. DOI: 10.1093/cid/ciaa635. (30 May 2020).
    https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa635/5848754
  9. Davies MA et al. Western Cape: COVID-19 and HIV/tuberculosis. Webinar: when epidemics collide. Bhekisisa Centre for Health Journalism. 9 June 2020.
    https://bhekisisa.org/multimedia/2020-06-09-standing-by-when-epidemics-collide-does-hiv-tb-cause-worse-covid-19/(webinar)
    https://storage.googleapis.com/stateless-bhekisisa-website/wordpress-uploads/2020/06/94d3ea42-covid_update_bhekisisa_wc_3.pdf (Mary-Ann Davies’ presentation pdf)
  10. Clayden P. HIV positive people in South Africa at increased risk of dying from COVID-19: first data from country with high prevalence of HIV and TB. HTB. (17 June 2020).
    http://i-base.info/htb/38232

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