{"id":37542,"date":"2020-04-17T07:46:18","date_gmt":"2020-04-17T07:46:18","guid":{"rendered":"http:\/\/i-base.info\/htb\/?p=37542"},"modified":"2020-05-25T13:17:44","modified_gmt":"2020-05-25T13:17:44","slug":"similar-rates-of-self-reported-covid-19-symptoms-in-people-who-are-hiv-positive-results-from-observational-cohort-in-wuhan-city-china","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/37542","title":{"rendered":"COVID-19 symptoms in HIV positive people similar to general population in Wuhan\u00a0"},"content":{"rendered":"
<\/span>Simon Collins, HIV i-Base<\/strong><\/div>\n
<\/div>\n

The most substantial data to inform risk of HIV and COVID-19 coinfection so far is an analysis from China. However, this is based on self-reported symptoms and the paper is not yet peer reviewed \u2013 published only in draft form ahead of press in the Lancet.<\/strong><\/p>\n

Wuhan city in Hubei province has a population of about 9 million people which includes about 6000 people who are HIV positive.<\/p>\n

During the coronavirus outbreak, and up to 2 March 2020, at least 49,300 people tested positive for CoV-2 and 2227 residents died from COVID-19.<\/p>\n

This paper included a subset of 1178 HIV positive people in two central districts in Wuhan. All participants were prospectively contacted by telephone and those reporting symptoms tested by PCR for CoV-2 and by CT scan for COVID-19. Face-to-face contact was limited due to lock down restrictions. The two districts included approximately 1,800,000 residents and reported 9,000 cases of COVID-19.<\/p>\n

Of the 12\/1178 people who reported symptoms, 8\/12 were confirmed as COVID-19 (6\/8 by PCR, 2\/8 by CT – and 4\/12 were excluded). All eight had undetectable viral load (<20 copies\/mL) and were taking NNRTI-based ART, 6\/8 with CD4 counts >350 and 2\/8 between 100 to 350 cells\/mm3<\/sup>.<\/p>\n

Of these 8 cases, 6\/8 were mild, 1 was severe, and 1 was a critical case who died.<\/p>\n

Of the 1162 HIV positive people without symptoms, nine were in close household contact with people who had confirmed COVID-19. Of these, only 1\/9 was confirmed positive for CoV-2 by PCR. This person had only recently been diagnosed with a very low CD4 count (27 cells\/mm3<\/sup>), had received ART for less than one month and was on chemotherapy for KS.<\/p>\n

The cohort also included 41 people with CD4 counts <100 cells\/mm3<\/sup>, with only one of these having reported possible symptoms. In the discussion, the paper suggested that a low CD4 count might not reflect lower CoV-2 incidence but masking of symptoms of COVID-19 (but clearly not for the case mentioned above).<\/p>\n

Based on self-reported symptoms the rate of COVID-19 in people living with HIV was estimated as 0.68% (95%CI: 0.29% to 1.34%). This was slightly higher than reported for general population in Wuhan (~0.5%) but similar to the overall estimated population rate of 0.83% (75 thousand out of 9 million).<\/p>\n

In multivariate analysis, including age, gender, CD4 counts, viral load, and type of ART, only older age was significantly associated with higher risk of COVID-19 (p=0.010).\u00a0The median age of the eight people with COVID-19 was 57.0 years old (95%CI: 47.5 to 61.5) compared to 36.0 (95%CI: 30.0 to 51.0) of those without COVID-19 (n=1166).<\/p>\n

The paper discussed the role of other antiretrovirals in COVID-19. Although no cases were reported among the 178 people taking lopinavir\/r, the study was underpowered to comments on individual drugs. Any possible role (would be for antiviral activity in early stage infection rather than in later COVID-19 when organ damage is caused by inflammation.<\/p>\n

This reason is given to support the Chinese guidelines (versions 1 to 6) to use corticosteroids to treat COVID-19 to suppress the inflammatory cytokine storm. Other experts, including WHO, disagree with this approach based on several meta-analyses that highlight risk of harm. [2, 3]<\/p>\n

comment<\/h3>\n

This study is welcome for providing some level of direct evidence that HIV positive people in Wuhan were not disproportionately affected by COVID-19. This is helpful in terms of concerns that incidence might be higher and outcomes might be worse.<\/strong><\/p>\n

The limitations from the study (other than lack of peer-review) is the reliance on self-reported symptoms and limiting testing to either those people who were symptomatic or at highest household risk. It doesn\u2019t therefore provide data on incidence and prevalence of CoV-2 which will need antibody testing.<\/strong><\/p>\n

Also, behavioural data on travel and risk was not available, including whether those with lowest CD4 counts were already self-isolating to minimise risk.<\/strong><\/p>\n

While these data are important, we still have much to learn.<\/strong><\/p>\n

It is therefore important that all cases of COVID-19 with either pneumonia or respiratory failure in the UK have their HIV status recorded and the people without a recent negative result are routinely tested for HIV. [4]<\/strong><\/p>\n

These two low-cost initiatives would improve the management of both HIV and COVID-19 care.<\/strong><\/p>\n

Recent studies of lopinavir\/r have reported conflicting results but a recent UK study was announced also using dexamethasone. [5, 6, 7, 8]<\/strong><\/p>\n

References<\/p>\n

    \n
  1. Guo W et al .\u00a0A survey for COVID-19 among HIV\/AIDS patients in two districts of Wuhan China. Lancet.\u00a0DOI:\u00a010.2139\/ssrn.3550029<\/a>\u00a0(13 March 2020)
    \n    https:\/\/papers.ssrn.com\/sol3\/papers.cfm?abstract_id=3550029<\/a><\/li>\n
  2. WHO. Clinical management of severe acute respiratory infection when novel coronavirus infection is suspected. (13 March 2020)
    \n    www.who.int\/publications-detail\/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected<\/a><\/li>\n
  3. \n
  4. Geretti AM, Collins S, Kelly S, Waters L. COVID-19 and HIV: Calling attention to the importance of ensuring HIV status and testing is included in the management of COVID-19. BMJ web blog. (7 April 2020).
    \n    https:\/\/blogs.bmj.com\/sti\/2020\/04\/07\/covid-19-and-hiv-calling-attention-to-the-importance-of-ensuring-hiv-status-and-testing-is-included-in-the-management-of-covid-19<\/a><\/li>\n
  5. Cao B et al. A trial of lopinavir\u2013ritonavir in adults hospitalized with severe Covid-19. NEJM. DOI: 10.1056\/NEJMoa2001282. (18 March 2020).
    \n    https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa2001282\u00a0<\/span><\/a><\/li>\n
  6. Deng L et al. Arbidol combined with LPV\/r versus LPV\/r alone against corona virus disease 2019: a retrospective cohort study. <\/b>Journal of Infections.\u00a0 doi: 10.1016\/j.jinf.2020.03.002. (11 Mar 2020).
    \n    https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/32171872<\/span><\/a><\/li>\n
  7. Li Y et al. An exploratory randomized, controlled study on the efficacy and safety of lopinavir\/ritonavir or arbidol treating adult patients hospitalized with mild\/moderate COVID-19 (ELACOI). MedRxIV. 23 March 2020.
    \n<\/b><\/span>    https:\/\/www.medrxiv.org\/content\/10.1101\/2020.03.19.20038984v1<\/span><\/a><\/li>\n
  8. Reuters Health News. <\/span>UK begins trial of HIV medicine, steroid as possible COVID-19 treatments (23 March 2020).
    \n    https:\/\/www.reuters.com\/article\/us-health-coronavirus-britain-tests\/uk-begins-trial-of-hiv-medicine-steroid-as-possible-covid-19-treatments-idUSKBN21A2JO<\/span><\/a><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Simon Collins, HIV i-Base The most substantial data to inform risk of HIV and COVID-19 coinfection so far is an analysis from China. However, this is based on self-reported symptoms and the paper is not yet peer reviewed \u2013 published …<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[282,278],"tags":[],"class_list":["post-37542","post","type-post","status-publish","format-standard","hentry","category-covid-19-hiv-and-covid-19-coinfection","category-covid-19"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/37542","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=37542"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/37542\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=37542"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=37542"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=37542"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}