Recent studies on HIV and COVID-19 coinfection

Simon Collins, HIV i-Base

The following papers have been published that include clinical outcomes on HIV positive people who were diagnosed with COVID-19, with brief summaries from the abstract.

Virologic and immunologic outcomes for HIV patients with coronavirus disease 2019

Hu R et al. JAIDS. doi: 10.1097/QAI.0000000000002540. (15 October 2020).

Results from 35 HIV positive people showing higher viral load after recovery from COVID-19.

“Twenty of the 35 co-infected patients were identified as asymptomatic/mild/moderate COVID-19 (non-severe group) and 15 were identified as severe/critical (severe group). The severe and non-severe group had no differences in demographics, HIV baseline status, the intervals between last tests and follow-up tests for CD4 cell count and HIV viral load (all p>0.05). Overall, there was a significantly increased number of co-infected patients with HIV-1 viral load ≥20 copies/mL after recovery (p=0.008). The median viral load increased significantly after recovery in severe group (p=0.034) while no significant change of HIV viral load was observed in non-severe group. Limited change of CD4 cell count was found (all p>0.05).”

AIDS October 2020: Special selection on HIV and COVID-19

The following articles are included in the 1 October edition of AIDS. This issue of HTB include links to both editorial comment and clinical studies from this edition.

Editorial introduction

Michael Saag. AIDS. 34(12):1755-1756, October 1, 2020.

What one pandemic can teach us in facing another

Wafaa El-Sadr, AIDS. 34(12):1757-1759, October 1, 2020.

Preserving 2 decades of healthcare gains for Africa in the coronavirus disease 2019 era

Sonak Pastakia et al. AIDS. 34(12):1761-1763, October 1, 2020.

Coronavirus disease 2019 attack rate in HIV-infected patients and in preexposure prophylaxis users

Charre, C et al. AIDS. 34(12):1765-1770, October 1, 2020.

Retrospective database analysis, with very small numbers of HIV positive and PrEP users that reported similar incidence in all groups.

“From March to April 2020, of 24,860 samples from 19,113 patients (HIV positive 77, PrEP users 27, others 19,009) were assessed for SARS-CoV-2 PCR assay. The positivity rate appeared similar in HIV positive patients (15.6%), PrEP users (14.8%) and other patients (19.1%). The crude/corrected COVID-19 attack rate appeared similar in HIV positive patients (0.31/0.38%) and in PrEP users (0.38/0.42%), and of the same order as the estimated attack rate in the general population (0.24%).”

HIV infection and COVID-19 risk factors for severe disease

Etienne N et al. Research letter, AIDS:;34(12):1771-1774.doi: 10.1097/QAD.0000000000002651. (1 October 2020).

“We performed an observational prospective monocentric study in patients living with HIV diagnosed with COVID-19. Fifty four HIV positive people developed COVID-19 with respectively 14 severe (25.9%) and 5 critical cases (9.3%). By multivariate analysis, age, male gender, ethnic origin from Sub Saharan Africa, and metabolic disorder, were associated with severe or critical forms of COVID-19. Prior CD4 cell counts did not differ between groups. No protective effect of a particular antiretroviral class was observed.”

Clinical characteristics, risk factors, and incidence of symptomatic coronavirus disease 2019 in a large cohort of adults living with HIV

Inciarte A et al. AIDS: October 1, 2020 – Volume 34 – Issue 12 – p 1775-1780. doi: 10.1097/QAD.0000000000002643.,_risk_factors,_and.11.aspx

Prospective observational study of 53 HIV positive people diagnosed with COVID-19.

From 1 March 2020 to 10 May 2020, 53 out of 5683 (0.9% confidence interval 0.7–1.2%) people living with HIV were diagnosed with COVID-19. Median age was 44 years, CD4 count was 618 cells/mm3and CD4/CD8 was 0.90. All but two individuals were virologically suppressed. Cough (87%) and fever (82%) were the most common symptoms. Twenty-six (49%) were admitted, six (14%) had severe disease, four (8%) required ICU admission, and two (4%) died. Several laboratory markers (lower O2 saturation and platelets, and higher leukocytes, creatinine, lactate dehydrogenase, C reactive protein, procalcitonin, and ferritin) were associated with COVID-19 severity. No HIV or ARV-related factors were associated with COVID-19 diagnosis or severity. Standardised incidence rate ratios of confirmed or confirmed/probable COVID-19 in HIV positive people were 38% (95%CI: 27 to 52%, p<0.0001) and 33% (95% CI: 21 to 50%, p<0.0001), respectively relative to the general population.”

Disproportionate burden of coronavirus disease 2019 among racial minorities and those in congregate settings among a large cohort of people with HIV

Meyerowitz EA et al. AIDS. 34(12):1781-1787, October 1, 2020.

US report on 26 HIV positive people diagnosed with COVID-19 during March – April 2020 in Massachusetts and impact of non-HIV risk factors and racial disparities.

We describe a cohort of 36 HIV positive people with confirmed COVID-19 and another 11 patients with probable COVID-19. Almost 85% of HIV positive with confirmed COVID-19 had a comorbidity associated with severe disease, including obesity, cardiovascular disease, or hypertension. Approximately 77% of HIV positive with COVID-19 were non-Hispanic Black or Latinx whereas only 40% of the HIV positive people in our clinic were Black or Latinx. Nearly half of HIV positive people with COVID-19 had exposure to congregate settings. In addition to people with confirmed COVID-19, we identified another 11 individuals with probable COVID-19, almost all of whom had negative PCR testing.”

Clinical characteristics, comorbidities and outcomes among persons with HIV hospitalised with coronavirus disease 2019 in Atlanta, Georgia

Collins LF et al. AIDS. 34(12):1789-1794, October 1, 2020.,_comorbidities_and.13.aspx

US case series of all HIV positive people diagnosed with COVID-19 at three hospitals in Atlanta.

Of 530 confirmed COVID-19 cases hospitalised during this period, 20 occurred among PWH (3.8%). The median age was 57 (Q1–Q3, 48–62) years, 65% were men, and 85% were non-Hispanic Black. Presenting median symptom duration was 5 (Q1–Q3, 3–7) days; cough (90%), fever (65%), malaise (60%) and dyspnea (60%) were most common. On admission, 40% of patients required oxygenation support and 65% had an abnormal chest radiograph. Median length of hospitalisation was 5 days (Q1 to Q3, 4 to 12), 30% required intensive care, 15% required intubation, and 15% died. Median CD4 cell count prior to admission was 425 (Q1–Q3, 262–815) cells/mm3and 90% of patients had HIV-1 RNA less than 200 copies/mL. Half of the patients had at least five comorbidities; hypertension (70%), dyslipidemia (60%) and diabetes (45%) were most prevalent. All three patients who died had CD4+ cell count more than 200, HIV suppression and each had a total of five comorbidities.”

Comorbidity indices in people with HIV and considerations for coronavirus disease 2019 outcomes

Winston A et al. AIDS. 34(12):1795-1800, October 1, 2020.

A cross-sectional study looking for comorbidity indices of COVID-19 among older HIV positive people and a matched HIV negative control group (POPPY study).

The 699 HIV positive and 304 HIV negative controls were predominantly male (87.5% vs. 64.0%), white (86.3% vs. 90.0%) and had median ages of 57 and 58 years, respectively. Among PWH, the median (IQR) CD4count was 624 (475 to 811) cells/mm3; 98.7% were on ART. The median (IQR) ECI was 0 (0 to 8) and 0 (−3 to 1), Charlson Comorbidity Index was 2 (1 to 5) and 1 (0 to 1) and Comorbidity Burden Index 8.6 (2.2, 16.8) and 5.9 (0.6, 10.8), respectively. While all three indices were significantly higher in PWH than in controls (p<0.001 for each), the magnitude of the differences between the two groups were small to medium, with effect sizes (95%CI) of 0.21 (0.16 to 0.27), 0.38 (0.32 to 0.42) and 0.18 (0.11 to 0.23), respectively.”

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