The potential #effect of #COVID19-related #disruptions on #HIV #incidence and HIV-related #mortality among #MSM in the #USA: a modelling study (Lancet HIV, abstract)

[Source: Lancet HIV, full page: (LINK). Abstract, edited.]

The potential effect of COVID-19-related disruptions on HIV incidence and HIV-related mortality among men who have sex with men in the USA: a modelling study

Kate M Mitchell, PhD, Dobromir Dimitrov, PhD, Romain Silhol, PhD, Lily Geidelberg, MSc, Mia Moore, PhD, Albert Liu, MD, Prof Chris Beyrer, MD, Prof Kenneth H Mayer, MD, Stefan Baral, MD, Prof Marie-Claude Boily, PhD

Published: February 19, 2021 | DOI: https://doi.org/10.1016/S2352-3018(21)00022-9

Summary

Background

During the COVID-19 pandemic, men who have sex with men (MSM) in the USA have reported similar or fewer sexual partners and reduced HIV testing and care access compared with before the pandemic. Pre-exposure prophylaxis (PrEP) use has also declined. We aimed to quantify the potential effect of COVID-19 on HIV incidence and HIV-related mortality among US MSM.

Methods

We used a calibrated, deterministic, compartmental HIV transmission model for MSM in Baltimore (MD, USA) and available data on COVID-19-related disruptions to HIV services to predict effects of reductions in sexual partners (0%, 25%, 50%), condom use (5%), HIV testing (20%), viral suppression (10%), PrEP initiations (72%), PrEP adherence (9%), and antiretroviral therapy (ART) initiations (50%). In our main analysis, we modelled disruptions due to COVID-19 starting Jan 1, 2020, and lasting 6 months. We estimated the median change in cumulative new HIV infections and HIV-related deaths among MSM over 1 and 5 years, compared with a base case scenario without COVID-19-related disruptions.

Findings

A 25% reduction in sexual partners for 6 months among MSM in Baltimore, without HIV service changes, could reduce new HIV infections by median 12·2% (95% credible interval 11·7 to 12·8) over 1 year and median 3·0% (2·6 to 3·4) over 5 years. In the absence of changes in sexual behaviour, the 6-month estimated reductions in condom use, HIV testing, viral suppression, PrEP initiations, PrEP adherence, and ART initiations combined are predicted to increase new HIV infections by median 10·5% (5·8 to 16·5) over 1 year, and by median 3·5% (2·1 to 5·4) over 5 years. Disruptions to ART initiations and viral suppression are estimated to substantially increase HIV-related deaths (ART initiations by median 1·7% [0·8 to 3·2], viral suppression by median 9·5% [5·2 to 15·9]) over 1 year, with smaller proportional increases over 5 years. The other individual disruptions (to HIV testing, PrEP and condom use, PrEP initiation, and partner numbers) were estimated to have little effect on HIV-related deaths (<1% change over 1 or 5 years). A 25% reduction in sexual partnerships is estimated to offset the effect of the combined service disruptions on new HIV infections (change over 1 year: median –3·9% [–7·4 to 1·0]; over 5 years: median 0·0% [–0·9 to 1·4]), but not on HIV deaths (change over 1 year: 11·0% [6·2 to 17·7]; over 5 years: 2·6% [1·5 to 4·3]).

Interpretation

Maintaining access to ART and adherence support is of the utmost importance to maintain viral suppression and minimise excess HIV-related mortality due to COVID-19 restrictions in the USA, even if disruptions to services are accompanied by reductions in sexual partnerships.

Funding

National Institutes of Health.

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Keywords: SARS-CoV-2; COVID-19; HIV/AIDS; USA.

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The #impact of the #COVID19 #lockdown on #HIV care in 65 #SouthAfrican primary care #clinics: an interrupted time series analysis (Lancet HIV, abstract)

[Source: Lancet HIV, full page: (LINK). Abstract, edited.]

The impact of the COVID-19 lockdown on HIV care in 65 South African primary care clinics: an interrupted time series analysis

Jienchi Dorward, MBChB, Thokozani Khubone, BTech, Kelly Gate, FCFP, Hope Ngobese, BCurr, Yukteshwar Sookrajh, MBChB, Siyabonga Mkhize, HSIDCCert, Aslam Jeewa, BEng, Christian Bottomley, PhD, Lara Lewis, MSc, Kathy Baisley, MSc, Prof Christopher C Butler, FMedSci, Nomakhosi Gxagxisa, MD, Nigel Garrett, PhD

Open Access | Published: February 04, 2021 | DOI: https://doi.org/10.1016/S2352-3018(20)30359-3

Summary

Background

The effect of the COVID-19 pandemic on HIV outcomes in low-income and middle-income countries is poorly described. We aimed to measure the impact of the 2020 national COVID-19 lockdown on HIV testing and treatment in KwaZulu-Natal, South Africa, where 1·7 million people are living with HIV.

Methods

In this interrupted time series analysis, we analysed anonymised programmatic data from 65 primary care clinics in KwaZulu-Natal province, South Africa. We included data from people testing for HIV, initiating antiretroviral therapy (ART), and collecting ART at participating clinics during the study period, with no age restrictions. We used descriptive statistics to summarise demographic and clinical data, and present crude summaries of the main outcomes of numbers of HIV tests per month, ART initiations per week, and ART collection visits per week, before and after the national lockdown that began on March 27, 2020. We used Poisson segmented regression models to estimate the immediate impact of the lockdown on these outcomes, as well as post-lockdown trends.

Findings

Between Jan 1, 2018, and July 31, 2020, we recorded 1 315 439 HIV tests. Between Jan 1, 2018, and June 15, 2020, we recorded 71 142 ART initiations and 2 319 992 ART collection visits. We recorded a median of 41 926 HIV tests per month before lockdown (January, 2018, to March, 2020; IQR 37 838–51 069) and a median of 38 911 HIV tests per month after lockdown (April, 2020, to July, 2020; IQR 32 699–42 756). In the Poisson regression model, taking into account long-term trends, lockdown was associated with an estimated 47·6% decrease in HIV testing in April, 2020 (incidence rate ratio [IRR] 0·524, 95% CI 0·446–0·615). ART initiations decreased from a median of 571 per week before lockdown (IQR 498–678), to 375 per week after lockdown (331–399), with an estimated 46·2% decrease in the Poisson regression model in the first week of lockdown (March 30, 2020, to April 5, 2020; IRR 0·538, 0·459–0·630). There was no marked change in the number of ART collection visits (median 18 519 visits per week before lockdown [IQR 17 074–19 922] vs 17 863 visits per week after lockdown [17 509–18 995]; estimated effect in the first week of lockdown IRR 0·932, 95% CI 0·794–1·093). As restrictions eased, HIV testing and ART initiations gradually improved towards pre-lockdown levels (slope change 1·183/month, 95% CI 1·113–1·256 for HIV testing; 1·156/month, 1·085–1·230 for ART initiations).

Interpretation

ART provision was generally maintained during the 2020 COVID-19 lockdown, but HIV testing and ART initiations were heavily impacted. Strategies to increase testing and treatment initiation should be implemented.

Funding

Wellcome Trust, Africa Oxford Initiative.

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Keywords: SARS-CoV-2; COVID-19; HIV/AIDS; South Africa.

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#COVID19 #Outcomes Among Persons Living With or Without Diagnosed #HIV Infection in #NY #State (Lancet Netw Open, abstract)

[Source: JAMA Network Open, full page: (LINK). Abstract, edited.]

COVID-19 Outcomes Among Persons Living With or Without Diagnosed HIV Infection in New York State

James M. Tesoriero, PhD1,2,3; Carol-Ann E. Swain, PhD1; Jennifer L. Pierce, BS1; Lucila Zamboni, PhD1; Meng Wu, PhD1; David R. Holtgrave, PhD2,3; Charles J. Gonzalez, MD1; Tomoko Udo, PhD2,3; Johanne E. Morne, MS1,3; Rachel Hart-Malloy, PhD1,3,4; Deepa T. Rajulu, MS1; Shu-Yin John Leung, MA1; Eli S. Rosenberg, PhD3,4

Author Affiliations: 1 New York State Department of Health, Albany; 2 Department of Health Policy Management and Behavior, University at Albany School of Public Health, State University of New York, Rensselaer; 3 Center for Collaborative HIV Research in Practice and Policy, University at Albany School of Public Health, State University of New York, Rensselaer; 4 Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer

JAMA Netw Open. 2021;4(2):e2037069. doi:10.1001/jamanetworkopen.2020.37069

Key Points

• Question  – Is there an association between prior diagnosis of HIV infection and coronavirus disease 2019 (COVID-19) diagnosis, hospitalization, and in-hospital death among residents of New York State?
• Findings  – In a cohort study of linked statewide HIV diagnosis, COVID-19 laboratory diagnosis, and hospitalization databases, persons living with an HIV diagnosis were more likely to receive a diagnosis of, be hospitalized with, and die in-hospital with COVID-19 compared with those not living with an HIV diagnosis. After demographic adjustment, COVID-19 hospitalization remained significantly elevated for individuals with an HIV diagnosis and was associated with elevated mortality.
• Meaning  – Persons living with an HIV diagnosis experienced poorer COVID-related outcomes (principally, higher rates of severe disease requiring hospitalization) relative to those without an HIV diagnosis.

Abstract

Importance  

New York State has been an epicenter for both the US coronavirus disease 2019 (COVID-19) and HIV/AIDS epidemics. Persons living with diagnosed HIV may be more prone to COVID-19 infection and severe outcomes, yet few studies have assessed this possibility at a population level.

Objective  

To evaluate the association between HIV diagnosis and COVID-19 diagnosis, hospitalization, and in-hospital death in New York State.

Design, Setting, and Participants  

This cohort study, conducted in New York State, including New York City, between March 1 and June 15, 2020, matched data from HIV surveillance, COVID-19 laboratory-confirmed diagnoses, and hospitalization databases to provide a full population-level comparison of COVID-19 outcomes between persons living with diagnosed HIV and persons living without diagnosed HIV.

Exposures  

Diagnosis of HIV infection through December 31, 2019.

Main Outcomes and Measures  

The main outcomes were COVID-19 diagnosis, hospitalization, and in-hospital death. COVID-19 diagnoses, hospitalizations, and in-hospital death rates comparing persons living with diagnosed HIV with persons living without dianosed HIV were computed, with unadjusted rate ratios and indirect standardized rate ratios (sRR), adjusting for sex, age, and region. Adjusted rate ratios (aRRs) for outcomes specific to persons living with diagnosed HIV were assessed by age, sex, region, race/ethnicity, transmission risk, and CD4+ T-cell count–defined HIV disease stage, using Poisson regression models.

Results  

A total of 2988 persons living with diagnosed HIV (2109 men [70.6%]; 2409 living in New York City [80.6%]; mean [SD] age, 54.0 [13.3] years) received a diagnosis of COVID-19. Of these persons living with diagnosed HIV, 896 were hospitalized and 207 died in the hospital through June 15, 2020. After standardization, persons living with diagnosed HIV and persons living without diagnosed HIV had similar diagnosis rates (sRR, 0.94 [95% CI, 0.91-0.97]), but persons living with diagnosed HIV were hospitalized more than persons living without diagnosed HIV, per population (sRR, 1.38 [95% CI, 1.29-1.47]) and among those diagnosed (sRR, 1.47 [95% CI, 1.37-1.56]). Elevated mortality among persons living with diagnosed HIV was observed per population (sRR, 1.23 [95% CI, 1.07-1.40]) and among those diagnosed (sRR, 1.30 [95% CI, 1.13-1.48]) but not among those hospitalized (sRR, 0.96 [95% CI, 0.83-1.09]). Among persons living with diagnosed HIV, non-Hispanic Black individuals (aRR, 1.59 [95% CI, 1.40-1.81]) and Hispanic individuals (aRR, 2.08 [95% CI, 1.83-2.37]) were more likely to receive a diagnosis of COVID-19 than White individuals, but they were not more likely to be hospitalized once they received a diagnosis or to die once hospitalized. Hospitalization risk increased with disease progression to HIV stage 2 (aRR, 1.29 [95% CI, 1.11-1.49]) and stage 3 (aRR, 1.69 [95% CI, 1.38-2.07]) relative to stage 1.

Conclusions and Relevance  

In this cohort study, persons living with diagnosed HIV experienced poorer COVID-related outcomes relative to persons living without diagnosed HIV; Previous HIV diagnosis was associated with higher rates of severe disease requiring hospitalization, and hospitalization risk increased with progression of HIV disease stage.

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Keywords: SARS-CoV-2; COVID-19; HIV/AIDS; New York State; USA.

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#Pneumocystis and #SARS-CoV-2 Co-Infection: A Case Report and Review of an Emerging Diagnostic Dilemma (Open Forum Infect Dis., abstract)

[Source: Open Forum Infectious Diseases, full page: (LINK). Abstract, edited.]

Pneumocystis and SARS-CoV-2 Co-Infection: A Case Report and Review of an Emerging Diagnostic Dilemma

Carlos Rubiano, MD, Kathleen Tompkins, MD, Subhashini A Sellers, MD MSc, Brian Bramson, MD, Joseph Eron, MD, Jonathan B Parr, MD MPH, Asher J Schranz, MD MPH

Open Forum Infectious Diseases, ofaa633, https://doi.org/10.1093/ofid/ofaa633

Published: 18 December 2020

Abstract

We present a case of a critically ill patient with COVID-19 found to have AIDS and Pneumocystis jirovecii pneumonia (PCP). COVID-19 and PCP co-occurrence is increasingly reported and may complicate diagnostic and therapeutic strategies. Patients with severe COVID-19 should be screened for underlying immunocompromise and coinfections should be considered.

Issue Section: Novel ID Cases

This content is only available as a PDF.

© The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

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Keywords: SARS-CoV-2; COVID-19; HIV/AIDS; Pneumocystis jirovecii.

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#HIV infection and #COVID19 #death: a population-based cohort analysis of #UK primary care data and linked national death registrations within the #OpenSAFELY platform (Lancet HIV, abstract)

[Source: Lancet HIV, full page: (LINK). Abstract, edited.]

HIV infection and COVID-19 death: a population-based cohort analysis of UK primary care data and linked national death registrations within the OpenSAFELY platform

Prof Krishnan Bhaskaran, PhD, Christopher T Rentsch, PhD, Brian MacKenna, MPharm, Anna Schultze, PhD, Amir Mehrkar, MBBChir, Chris J Bates, PhD, Rosalind M Eggo, PhD, Caroline E Morton, MBChB, Sebastian C J Bacon, BA, Peter Inglesby, MPhil, Prof Ian J Douglas, PhD, Alex J Walker, PhD, Helen I McDonald, Jonathan Cockburn, BSc, Elizabeth J Williamson, PhD, David Evans, MPhil, Harriet J Forbes, PhD, Helen J Curtis, DPhil, William J Hulme, PhD, John Parry, MRCGP, Frank Hester, BSc, Sam Harper, MSci, Stephen J W Evans, Liam Smeeth *, Ben Goldacre, MRCPsych *

Open Access | Published: December 11, 2020 | DOI: https://doi.org/10.1016/S2352-3018(20)30305-2

Summary

Background

Whether HIV infection is associated with risk of death due to COVID-19 is unclear. We aimed to investigate this association in a large-scale population-based study in England.

Methods

We did a retrospective cohort study. Working on behalf of NHS England, we used the OpenSAFELY platform to analyse routinely collected electronic primary care data linked to national death registrations. We included all adults (aged ≥18 years) alive and in follow-up on Feb 1, 2020, and with at least 1 year of continuous registration with a general practitioner before this date. People with a primary care record for HIV infection were compared with people without HIV. The outcome was COVID-19 death, defined as the presence of International Classification of Diseases 10 codes U07.1 or U07.2 anywhere on the death certificate. Cox regression models were used to estimate the association between HIV infection and COVID-19 death; they were initially adjusted for age and sex, then we added adjustment for index of multiple deprivation and ethnicity, and then for a broad range of comorbidities. Interaction terms were added to assess effect modification by age, sex, ethnicity, comorbidities, and calendar time.

Results

17 282 905 adults were included, of whom 27 480 (0·16%) had HIV recorded. People living with HIV were more likely to be male, of Black ethnicity, and from a more deprived geographical area than the general population. 14 882 COVID-19 deaths occurred during the study period, with 25 among people with HIV. People living with HIV had higher risk of COVID-19 death than those without HIV after adjusting for age and sex: hazard ratio (HR) 2·90 (95% CI 1·96–4·30; p<0·0001). The association was attenuated, but risk remained high, after adjustment for deprivation, ethnicity, smoking and obesity: adjusted HR 2·59 (95% CI 1·74–3·84; p<0·0001). There was some evidence that the association was larger among people of Black ethnicity: HR 4·31 (95% CI 2·42–7·65) versus 1·84 (1·03–3·26) in non-Black individuals (p-interaction=0·044).

Interpretation

People with HIV in the UK seem to be at increased risk of COVID-19 mortality. Targeted policies should be considered to address this raised risk as the pandemic response evolves.

Funding

Wellcome, Royal Society, National Institute for Health Research, National Institute for Health Research Oxford Biomedical Research Centre, UK Medical Research Council, Health Data Research UK.

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Keywords: SARS-CoV-2; COVID-19; HIV/AIDS; UK; Epidemiology.

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#COVID19 disease #spectrum in #children – first insights from #Africa (Clin Infect Dis., summary)

[Source: Clinical Infectious Diseases, full page: (LINK). Summary, edited.]

COVID-19 disease spectrum in children – first insights from Africa

Ben J Marais, Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI)  and The Children’s Hospital at Westmead, Sydney Medical School, University of  Sydney, Sydney, Australia.

Correspondence to: Ben J Marais, Clinical School, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, New South Wales, 2145, Sydney, Australia – Tel: +61-3-93454788 Fax: +61-3-93456667 – E-mail: ben.marais@health.nsw.gov.au

Keywords: COVID-19, SARS CoV-2; children; age differential

Downloaded from https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa1731/5981678 by guest on 14 November 2020

Accepted Manuscript

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Although the morbidity and mortility observed among older people with SARS CoV-2  infection is high, a consistent observation has been the low risk of severe disease in  children and young adults (1,2). In fact paediatric intensive care units were often  converted to accommodate adult patients in countries with major epidemic peaks  that overwhelmed the healh care system, given the low numbers of children  requiring intensive care compared to older adults. The pronounced age differential  observed with severe COVID-19 disease is different to the experience with SARS or  major influenza epidemics of the past and remains largely unexplained (1). Despite  their relative protection against adverse outcomes, instances of severe disease in  children do occur (3,4) and it is important to better understand the risk profile of  these children. In addition, disease rates in low and middle income countries (LMICs)  with higher rates of childhood malnutrition and human immunodeficiency  virus (HIV) infection have not been reported. Given that children in LMICs  experience increased vulnerability to other severe lower respiratory tract infections  (5), this is an important knowledge gap. To date, there has been no comprehensive  overview of the COVID-19 disease spectrum observed in children from sub-Sharan  Africa where malnutrition and HIV infection rates are high.

(…)

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Keywords: SARS-CoV-2; COVID-19; HIV/AIDS; Pediatrics; Africa.

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#Clinical #experience with #SARS CoV-2 related illness in #children – #hospital experience in Cape Town, #SouthAfrica (Clin Infect Dis., abstract)

[Source: Clinical Infectious Diseases, full page: (LINK). Abstract, edited.]

Clinical experience with SARS CoV-2 related illness in children – hospital experience in Cape Town, South Africa

Marieke M van der Zalm, Juanita Lishman, Lilly M Verhagen, Andrew Redfern, Liezl Smit, Mikhail Barday, Dries Ruttens, A’ishah da Costa, Sandra van Jaarsveld, Justina Itana, Neshaad Schrueder, Marije Van Schalkwyk, Noor Parker, Ilse Appel, Barend Fourie, Mathilda Claassen, Jessica J Workman, Pierre Goussard, Gert Van Zyl, Helena Rabie

Clinical Infectious Diseases, ciaa1666, https://doi.org/10.1093/cid/ciaa1666

Published: 10 November 2020

Abstract

Background

Children seem relatively protected from serious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) related disease, but little is known about children living in settings with high tuberculosis and HIV burden. This study reflects clinical data on South African children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Methods

We collected clinical data of children aged younger than 13 years with laboratory confirmed SARS-CoV-2 presenting to Tygerberg Hospital, Cape Town between 17th of April and 24th of July 2020.

Results

Hundred and fifty-nine children (median age 48·0 months (interquartile range, IQR 12·0-106·0)) were included. Hospitalized children (n=62), median age of 13·5 months (IQR 1·8-43·5) were younger than children not admitted (n=97), median age 81·0 months (IQR 34·5-120·5, p< 0·01). Thirty-three of 159 (20·8%) children had pre-existing medical conditions. Fifty-one of 62 (82·3%) hospitalized children were symptomatic; lower respiratory tract infection was diagnosed in 21/51 (41·2%) and 11/16 (68·8%) children younger than 3 months of age. Respiratory support was required in 25/51 (49·0%) children; 13/25 (52·0%) children were younger than 3 months. One child was HIV infected and 11/51 (21·2%) were HIV exposed uninfected and 7/51 (13·7%) children had a recent or new diagnosis of tuberculosis.

Conclusion

Children less than 1 year of age hospitalized with SARS-CoV-2 in Cape Town frequently required respiratory support, the access to oxygen may be limited in some LMICs which could potentially drive morbidity and mortality. HIV infection was uncommon but a relationship between HIV exposure, tuberculosis and SARS-CoV-2 should be explored.

COVID-19, Children, respiratory virus infections, MIS-C, Sub-Saharan Africa

Topic:  child – south africa – severe acute respiratory syndrome – towns – sars-cov-2

Issue Section: Major Article

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© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

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Keywords: SARS-CoV-2; COVID-19; HIV/AIDS; Tuberculosis; Pediatrics; S. Africa.

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#COVID19 and preventative #medicine for #HIV infected #children (Clin Infect Dis., summary)

[Source: Clinical Infectious Diseases, full page: (LINK). Summary, edited.]

COVID-19 and preventative medicine for HIV infected children

Lorato Anderson, MD, Pediatric HIV Fellow at St. Jude’s Children’s Research Hospital, Memphis, TN; Miguela Caniza, MD, MPH, Director, Global Infectious Diseases  Program, St. Jude Children’s Research Hospital, Memphis, TN

Corresponding author: Lorato Anderson, MD, Pediatric HIV Fellow at St. Jude’s  Children’s Research Hospital, Email: Lorato.Anderson@stjude.org, Phone: 609-456-3626

Downloaded from https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa1626/5939859 by guest on 26 October 2020

Accepted Manuscript

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Dear Editor, As pediatricians concentrating on global pediatric health, we read with  great interest the article by Congdon M, Hong H, Young RR, et al. published in the  July 2020 issue of Clinical Infectious Diseases. We were delighted to see the decrease  in pediatric hospitalizations and deaths attributed to pneumonia following the  implementation of Hib and PCV-13 vaccines in children in Botswana. We appreciate  the authors’ work but worry about the impact of COVID-19 on basic preventive  medicine, especially among HIV-infected children, a population at high risk of  preventable infections. Targeted and national vaccination strategies might be  necessary to prevent untimely deaths among these children during this pandemic.

(…)

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Keywords: SARS-CoV-2; COVID-19; Pediatrics; HIV/AIDS.

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#Outcomes of #COVID19 related #hospitalization among people with #HIV in the #ISARIC #WHO #Clinical Characterization Protocol (#UK): a prospective observational study (Clin Infect Dis., abstract)

[Source: Clinical Infectious Diseases, full page: (LINK). Abstract, edited.]

Outcomes of COVID-19 related hospitalization among people with HIV in the ISARIC WHO Clinical Characterization Protocol (UK): a prospective observational study

Anna Maria Geretti, Alexander J Stockdale, Sophie H Kelly, Muge Cevik, Simon Collins, Laura Waters, Giovanni Villa, Annemarie Docherty, Ewen M Harrison, Lance Turtle, Peter J M Openshaw, J Kenneth Baillie, Caroline A Sabin, Malcolm G Semple

Clinical Infectious Diseases, ciaa1605, https://doi.org/10.1093/cid/ciaa1605

Published: 23 October 2020

Abstract

Background

Evidence is conflicting about how HIV modulates COVID-19. We compared the presentation characteristics and outcomes of adults with and without HIV who were hospitalized with COVID-19 at 207 centers across the United Kingdom and whose data were prospectively captured by the ISARIC WHO CCP study.

Methods

We used Kaplan-Meier methods and Cox regression to describe the association between HIV status and day-28 mortality, after separate adjustment for sex, ethnicity, age, hospital acquisition of COVID-19 (definite hospital acquisition excluded), presentation date, ten individual comorbidities, and disease severity at presentation (as defined by hypoxia or oxygen therapy).

Results

Among 47,592 patients, 122 (0.26%) had confirmed HIV infection and 112/122 (91.8%) had a record of antiretroviral therapy. At presentation, HIV-positive people were younger (median 56 versus 74 years; p<0.001) and had fewer comorbidities, more systemic symptoms and higher lymphocyte counts and C-reactive protein levels. The cumulative day-28 mortality was similar in the HIV-positive vs. HIV-negative groups (26.7% vs. 32.1%; p=0.16), but in those under 60 years of age HIV-positive status was associated with increased mortality (21.3% vs. 9.6%; p<0.001 [log-rank test]). Mortality was higher among people with HIV after adjusting for age (adjusted hazard ratio [aHR] 1.47, 95% confidence interval [CI] 1.01-2.14; p=0.05), and the association persisted after adjusting for the other variables (aHR 1.69; 95% CI 1.15-2.48; p=0.008) and when restricting the analysis to people aged <60 years (aHR 2.87; 95% CI 1.70-4.84; p<0.001).

Conclusions

HIV-positive status was associated with an increased risk of day-28 mortality among patients hospitalized for COVID-19.

COVID-19, SARS-CoV-2, HIV, mortality

Issue Section: Major Article

This content is only available as a PDF.

© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America.

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

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Keywords: SARS-CoV-2; COVID-19; HIV/AIDS; ISARIC; WHO.

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Characteristics, #Comorbidities, and #Outcomes in a Multicenter Registry of Patients with #HIV and #Coronavirus Disease-19 (Clin Infect Dis., abstract9

[Source: Clinical Infectious Diseases, full page: (LINK). Abstract, edited.]

Characteristics, Comorbidities, and Outcomes in a Multicenter Registry of Patients with HIV and Coronavirus Disease-19

Dima Dandachi, MD, MPH, Grant Geiger, BS, Mary W Montgomery, MD, Savannah Karmen-Tuohy, BS, Mojgan Golzy, Ph.D, Annukka A R Antar, MD, Ph.D, Josep M Llibre, MD, Ph.D, Maraya Camazine, MS, Alberto Díaz-De Santiago, MD, Ph.D, Philip M Carlucci, BS, Ioannis M Zacharioudakis, MD, Joseph Rahimian, MD, Celestine N Wanjalla, MD Ph.D, Jihad Slim, MD, Folasade Arinze, MD, MPH, Ann Marie Porreca Kratz, PharmD, BCPS, BCIDP, Joyce L Jones, MD, MS, Shital M Patel, MD, MS, Ellen Kitchell, MD, Adero Francis, MD, Manoj Ray, MD, David E Koren, PharmD, John W Baddley, MD, MSPH, Brannon Hill, PharmD, Paul E Sax, MD, Jeremy Chow, MD, MS, HIV-COVID-19 consortium

Clinical Infectious Diseases, ciaa1339, https://doi.org/10.1093/cid/ciaa1339

Published: 09 September 2020

Abstract

Background

People with HIV (PWH) may have numerous risk factors for acquiring Coronavirus disease-19 (COVID-19) and developing severe outcomes, but current data are conflicting.

Methods

Healthcare providers enrolled consecutively by non-random sampling PWH with lab-confirmed COVID-19, diagnosed at their facilities between April 1st and July 1st, 2020. De-identified data were entered into an electronic Research Electronic Data Capture (REDCap). The primary endpoint was severe outcome, defined as a composite endpoint of intensive care unit (ICU) admission, mechanical ventilation, or death. The secondary outcome was the need for hospitalization.

Results

286 patients were included; the mean age was 51.4 years (SD, 14.4), 25.9% were female, and 75.4% were African-American or Hispanic. Most patients (94.3%) were on antiretroviral therapy (ART), 88.7% had HIV virologic suppression, and 80.8% had comorbidities. Within 30 days of positive SARS-CoV-2 testing, 164 (57.3%) patients were hospitalized, and 47 (16.5%) required ICU admission. Mortality rates were 9.4% (27/286) overall, 16.5% (27/164) among those hospitalized, and 51.5% (24/47) among those admitted to an ICU. The primary composite endpoint occurred in 17.5% (50/286) of all patients and 30.5% (50/164) of hospitalized patients. Older age, chronic lung disease, and hypertension were associated with severe outcomes. A lower CD4 count (<200 cells/mm³) was associated with the primary and secondary endpoints. There was no association between the antiretroviral regimen or lack of viral suppression and predefined outcomes.

Conclusion

Severe clinical outcomes occurred commonly in PWH and COVID-19. The risk for poor outcomes was higher in those with comorbidities and lower CD4 cell counts, despite HIV viral suppression.

HIV, COVID-19, SARS-CoV-2, AIDS

Issue Section:  Major Article

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Keywords: SARS-CoV-2; COVID-19; HIV/AIDS.

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