COVID-19 confers similar risk for severe disease in patients with, without HIV
Patients with COVID-19 who were also HIV-positive experienced a similar risk for severe disease, ICU admission and death due to COVID-19 compared with the general population, according to the results of a single-center study conducted in Italy.
“Initial information from China and evidence accumulated over recent weeks has allowed the identification of some of the risk factors associated with a negative prognosis [for patients with COVID-19], including aging, male gender, hypertension, diabetes mellitus and cardiovascular, lung and/or kidney diseases,” Cristina Gervasoni, MD, of the department of infectious diseases at ASST Fatebenefratelli Sacco University Hospital in Milan, and colleagues wrote. “However, little is known about the impact of HIV infection on the clinical outcomes of patients infected with SARS-CoV-2 because, to the best of our knowledge, only case reports or small case series have so far been published.”
Gervasoni and colleagues performed a retrospective study of nearly 6,000 patients with HIV to examine the clinical characteristics and outcomes of HIV-infected patients with a probable or proven COVID-19 diagnosis between Feb. 21 and April 20.
The researchers identified 47 patients with HIV and probable or confirmed COVID-19 (76% men; mean age, 51 ± 11 years), most of whom had suppressed HIV viremia and acceptable immune reconstitution, although three patients (all men) had detectable HIV viral loads. Nearly 64% of the patients identified as having COVID-19 (82% of the males and 58% of the females) had at least one comorbidity, the most common being dyslipidemia (32%), followed by arterial hypertension (30%) and hepatitis B or hepatitis C coinfections (11%). All patients with HIV and probable or confirmed COVID-19 were on ART.
More than half of the patients with probable or confirmed COVID-19 (n = 28) tested positive for the illness, including one female patient who was asymptomatic but tested because she was a health care provider. The other patients with confirmed or probable COVID-19 were not tested for the illness, “mainly because they lived in the high-risk provinces of Bergamo and Brescia (Lombardy), but were isolated at home and cared for by their general practitioners,” the researchers wrote. The diagnosis of COVID-19 in these patients was based on clinical symptoms and the presence of risk factors.
According to the study, 13 of the 28 patients with COVID-19 were hospitalized, including six with severe lung disease, two of whom required mechanical ventilation; one of these patients recovered and was discharged and the other, a 47-year-old overweight man with no other comorbidities, died. Gervasoni and colleagues identified another patient with cardiovascular disease and a recent diagnosis of lung cancer who died during hospitalization.
“For comparative purposes, the crude mortality rate of the HIV-negative, COVID-19 patients in our hospital (n = 502; 67% male; mean age, 61±16 years) is currently approximately 17%,” the researchers wrote.
Of all patients with confirmed and probable COVID-19, 45 recovered with no significant difference between women and men (11±7 vs. 14±9 days). Researchers noted that fewer than 50% of patients were given potential anti-COVID-19 treatments, specifically hydroxychloroquine (17%), azithromycin (15%) or lopinavir/ritonavir (11%), although one received tocilizumab and remdesivir and another received toxicizumab alone.
“Our findings suggest that HIV-positive patients with SARS-CoV-2 infection are not at greater risk [for] severe disease or death than HIV-negative patients,” the authors concluded. “However, the observed more favorable outcomes need to be confirmed in larger cohort studies.” – by Caitlyn Stulpin
Disclosures: Gervasoni reports receiving personal fees from Gilead, Janssen-Cilag, MSD and ViiV for services unrelated to the study. Please see the study for all other authors’ relevant financial disclosures.