Influence of HIV infection on clinical course of the new coronavirus infection (COVID-19)

Abstract

Background. The clinical course of COVID-19 infection can be significantly affected by severe immunosuppression, viral load, concomitant diseases and conditions not related to HIV, the absence of antiretroviral therapy. It is potentially important to assess the state of post-ovoid immunity for the provision of medical care to HIV-infected patients with COVID-19.
 Aim: to assess the impact of HIV infection on the clinical course of a new coronavirus infection, the severity of the disease and its outcomes, and immune response.
 Materials and methods. Medical records of 35,328 patients who underwent COVID-19 in 2020 were analyzed, including 46 cases of SARS-CoV-2 infection in HIV-infected individuals. To determine specific antibodies to SARS-CoV-2, 281 blood samples were examined by ELISA. The clinical course of COVID-19 in HIV-infected patients, as well as the production of IgG to SARS-CoV-2, depending on the level of CD4 and viral load, were assessed.
 Results. In 76% of co-infected patients, there were signs of progression of HIV infection, opportunistic infections and concomitant diseases. 52.2% of the analyzed group were users of psychoactive substances. Among patients co-infected with HIV and COVID-19, men predominated in the age groups over 30 years old, while among the HIV-negative population, women in the age groups over 18 years old predominated. The proportion of severe forms of COVID-19 in HIV-infected people (47.8%) exceeds that in the group of patients without immunodeficiency (12.3%). The mortality rate from COVID-19 among HIV-infected people was more than 7 times higher than that of the HIV-negative population of the region (t=1.81; p=0.01). Among the examined 72 HIV-infected patients, IgG antibodies to SARS-CoV-2 were detected in 20 patients, of which 4 (28.5%) with confirmed HIV/SARS-CoV-2 co-infection and 16 people (27.5%) without medical confirmation. HIV-infected patients with severe immunodeficiency did not develop a humoral immune response to COVID-19 infection, and in 25% the immune response lasted less than 3 months.
 Conclusions. HIV-infected patients are at greater risk of developing a severe course of coronavirus infection. The presence of deep immunodeficiency and high viral load in patients without antiretroviral therapy significantly reduces tension and shortens the development and duration of post-COVID immunity.