Clinical characteristics and outcomes of people living with HIV hospitalized with COVID-19: a nationwide experience

Abstract

In this prospective, multicentric, observational study, we describe the clinical characteristics and outcomes of people living with HIV (PLHIV) requiring hospitalization due to COVID-19 in Chile and compare them with Chilean general population admitted with SARS-CoV-2. Consecutive PLHIV admitted with COVID-19 in 23 hospitals, between 16 April and 23 June 2020, were included. Data of a temporally matched-hospitalized general population were used to compare demography, comorbidities, COVID-19 symptoms, and major outcomes. In total, 36 PLHIV subjects were enrolled; 92% were male and mean age was 44 years. Most patients (83%) were on antiretroviral therapy; mean CD4 count was 557 cells/mm3. Suppressed HIV viremia was found in 68% and 56% had, at least, one comorbidity. Severe COVID-19 occurred in 44.4%, intensive care was required in 22.2%, and five patients died (13.9%). No differences were seen between recovered and deceased patients in CD4 count, HIV viral load, or time since HIV diagnosis. Hypertension and cardiovascular disease were associated with a higher risk of death ( p = 0.02 and 0.006, respectively). Compared with general population, the HIV cohort had significantly more men (OR 0.15; IC 95% 0.07–0.31) and younger age (OR 8.68; IC 95% 2.66–28.31). In PLHIV, we found more intensive care unit admission (OR 2.31; IC 95% 1.05–5.07) but no differences in the need for mechanical ventilation or death. In this cohort of PLHIV hospitalized with COVID-19, hypertension and cardiovascular comorbidities, but not current HIV viro-immunologic status, were the most important risk factors for mortality. No differences were found between PLHIV and general population in the need for mechanical ventilation and death.

Prevalence and Mortality due to COVID-19 in HIV Co-Infected Population: A Systematic Review and Meta-Analysis

“…A total of 3,344 articles were retrieved from electronic databases up to 9 March 2021. After the removal of irrelevancy and duplicates, 83 articles were taken for fulltext screening, and, finally, 14 studies providing outcomes of interest were included for review [4,5,[13][14][15][16][17][18][19][20][21][22][23][24]. Of these included studies 13 were peer-reviewed, while 1 case series was unpublished [19].…”

“…Table 1 outlines the characteristics and data extracted from the included studies. Nine studies were of cohort design [4,5,13,15,17,18,[20][21][22] and the other five were case series [14,16,19,23,24]. Only one cohort study used matched population design while comparing PLWHA and non-PLWHA [21].…”

“…Seven of the studies were conducted in Europe (England, UK [18], Italy [14,20], Spain [13], France [17]), Germany [24], and Central/East European countries [19]. The others were from Asia (China [5]), Africa (Western Cape [4]), North America (United States [16,[21][22][23]), and South America (Chile [15]), respectively. Four of the cohort studies used a mass database(provincial/national) for population recruitment [4,5,18,22], another two had a multi-center involvement [13,15], and three studies had a single-center involvement [17,20,21].…”

“…The others were from Asia (China [5]), Africa (Western Cape [4]), North America (United States [16,[21][22][23]), and South America (Chile [15]), respectively. Four of the cohort studies used a mass database(provincial/national) for population recruitment [4,5,18,22], another two had a multi-center involvement [13,15], and three studies had a single-center involvement [17,20,21]. Four out of the five case series were of a multi-center design [14,16,19,24].…”

Co-infections as Modulators of Disease Outcome: Minor Players or Major Players?

“…Such retrospective study leads to a understanding that irrespective of HIV status, patients with COVID-19 still have low counts of CD4+ T cells. However, some studies reported poorer COVID-19 related outcomes in patients living with HIV ( Ceballos et al, 2021 ; Tesoriero et al, 2021 ). The divergent findings in the case of HIV–SARS-CoV-2 co-infection warrant a thorough investigation into the immunological aspects of SARS-CoV-2 co-infection with HIV.…”