Features of the clinical course of COVID-19 in people living with HIV

Abstract

Purpose. To study the features of the clinical course of coronavirus infection (COVID-19) in people living with HIV and risk factors for adverse outcomes.Materials and methods. The study included 523 patients with a confirmed diagnosis of COVID-19 occurring against the background of HIV infection and hospitalized from March 2020 to September 2021 on the basis of the GBUZ “S.P. Botkin KIB” in St. Petersburg. Two groups were formed: 1 – receiving antiretroviral therapy (n=204), 2 – not receiving ART (n=319). A comparative analysis of the results obtained during the examination was carried out using statistical methods: Mann-Whitney (p≤0.05) and the calculation of the relative risk (RR) when comparing the probability of the outcome of the disease depending on the presence of risk factors: respiratory rate ( NPV),% lung damage, levels of CD4 and C-reactive protein (CRP) with a significance level of p≤0.05.Results. Among the patients, persons aged 30 to 49 years predominated. In 50.5% of cases, coronavirus infection proceeded in the form of acute respiratory viral infections, pneumonia was diagnosed in 49.5%, which was subsequently complicated in 22.9% by the development of acute respiratory distress syndrome or sepsis in 2.1%. Severe course of COVID-19 was observed in non-adherent to ART, with CD4 lymphocyte count (≤50 cells/µl), multimorbidity and amounted to 45%.Conclusion. A feature of the course of COVID-19 in patients with HIV/SARS-COV-2 coinfection was a high number of deaths – 21.6%. In the overall structure of causes of death, the maximum share fell on HIV infection – 58.4%, COVID-19 – 24.8%, HIV/ COVID-19 –9.7% coinfection and other causes – 7.1%. Factors associated with the development of severe forms of coronavirus infection caused by SARS-COV-2 in HIV-infected patients who were hospitalized, the combination of which can be used as a predictor of death, have been identified: respiratory rate (RR) > 20 per minute, percentage of involvement lungs> 50%, CD4 lymphocyte level <40 cells/µl, CRP>50 mg/l, presence of three or more concomitant diseases.