{"id":38980,"date":"2020-10-14T07:32:02","date_gmt":"2020-10-14T07:32:02","guid":{"rendered":"https:\/\/i-base.info\/htb\/?p=38980"},"modified":"2020-10-18T13:55:32","modified_gmt":"2020-10-18T13:55:32","slug":"us-study-of-hiv-positive-people-with-covid-19-reports-worse-outcomes-with-comorbidities-and-having-a-cd4","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/38980","title":{"rendered":"US study of HIV positive people with COVID-19 reports worse outcomes with comorbidities and having a CD4 <200"},"content":{"rendered":"
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Simon Collins, HIV i-Base<\/span><\/strong><\/p>\n<\/div>\n

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A large prospective US study on COVID-19 in people living with HIV has reported worse outcomes associated with multiple comorbidities. It also reports a link to lower CD4 counts that has not been seen in other studies, even when on effective ART. [1]<\/span><\/strong><\/p>\n<\/div>\n

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This study, published on 9 September 2020 in Clinical Infectious Diseases, included 286 participants diagnosed with confirmed COVID-19 between 1 April and 1 July 2020. Cases were submitted by a range of 36 US medical providers from 21 States to a multicentre registry at University of Missouri. Just under half these cases (47%) were from the US South. Three international centres also reported 21 cases. Multivariate analyses were run to determine risk factors for worse outcomes.<\/span><\/p>\n<\/div>\n

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The mean age was 51.4 years (SD: 14.4), 26% were female, and 47.5% were African-American and 28% were Hispanic. Most patients (94%) were on ART, 89% had HIV virologic suppression, and mean CD4 counts was 531 cells\/mm3\u00a0<\/sup>(SD 340). Five duplicate cases were removed.<\/span><\/p>\n<\/div>\n

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Overall, 81% had significant comorbidities including hypertension (46%), obesity (32%), and diabetes (21%).<\/p>\n<\/div>\n

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Within 30 days of confirmed COVID-19, 164 (57%) patients were hospitalised and 47 (16.5%) required ICU admission. Mortality rates were 9.4% (27\/286) overall, 16.5% (27\/164) among those hospitalised, and 51.5% (24\/47) among those admitted to an ICU. The primary composite endpoint of ICU admission, mechanical ventilation or death occurred in 17.5% (50\/286) overall and in 30.5% (50\/164) of those hospitalised.<\/p>\n<\/div>\n

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Hospitalisation was associated with older age (p<0.01), lower CD4 counts (p<0.01), number of years living with HIV (p<0.01), not being on ART (p=0.04) or being virally suppressed (p=0.02), and high comorbidity burden (p<0.01). <\/span><\/p>\n<\/div>\n

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Multivariate analysis showed older age (p=0.02), CD4 count <200 (p=0.05), chronic lung disease (p<0.01), hypertension (p=0.01), and high (3+) comorbidity burden (p=0.05) were significantly associated with severe outcomes.<\/span><\/p>\n<\/div>\n

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Based on 47 participants admitted to an ICU and 27 who died, CD4 cell count had a significant effect on survival. Having a CD4 count <200 vs >500 cells\/mm3\u00a0<\/sup>was significantly related to both lower ICU-free survival (p=0.04) and overall survival (p=0.05).<\/span><\/p>\n<\/div>\n

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Although submission to the registry may have included selection bias, the paper notes that 17\/36 clinics included all cases of COVID-19 diagnosis. Other limitations for this study included limited data on steroid use and enrollment in COVID-19 research studies.<\/span><\/p>\n<\/div>\n

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The researchers reported that the rates of ICU admission, use of mechanical ventilation, and mortality among HIV positive people with COVID-19 were similar to US general population data. Sensitivity analyses using only US participants did not affect the overall results.<\/span><\/p>\n<\/div>\n

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However, this is the largest study to report an association between lower CD4 counts (<200) and worse primary and secondary outcomes from COVID-19, irrespective of viral suppression on ART. These data also disprove an early hypothesis that immune dysfunction might be protective of COVID-19.<\/span><\/p>\n<\/div>\n

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An earlier US case-control study reporting a link to lower CD4 count only included 21 HIV positive people. [2]<\/span><\/p>\n<\/div>\n

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References<\/b><\/p>\n<\/div>\n

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  1. Dandachi\u00a0D et al. Characteristics, comorbidities, and outcomes in a multicenter registry of patients with HIV and coronavirus disease-19. Clinical Infectious Diseases, ciaa1339,\u00a0DOI: 10.1093\/cid\/ciaa1339. (09 September 2020).
    \nhttps:\/\/academic.oup.com\/cid\/advance-article\/doi\/10.1093\/cid\/ciaa1339\/5903368<\/a><\/li>\n
  2. Karmen-Tuohy S et al. Outcomes among\u00a0HIV-positive patients hospitalized with\u00a0COVID-19. JAIDS. DOI: 10.1097\/QAI.0000000000002423.
    \n    https:\/\/journals.lww.com\/jaids\/Abstract\/9000\/Outcomes_among_HIV_positive_patients_hospitalized.96152.aspx<\/a><\/li>\n<\/ol>\n

    This report was first published on 11 September 2020.<\/em><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

    Simon Collins, HIV i-Base A large prospective US study on COVID-19 in people living with HIV has reported worse outcomes associated with multiple comorbidities. It also reports a link to lower CD4 counts that has not been seen in other …<\/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-38980","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\/38980","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=38980"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/38980\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=38980"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=38980"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=38980"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}