Clinical Outcomes and Inflammatory Markers by HIV Serostatus and Viral Suppression in a Large Cohort of Patients Hospitalized With COVID-19

Abstract

Background: Limited data exist about clinical outcomes and levels of inflammatory and immune markers among people hospitalized with COVID-19 by HIV serostatus and by HIV viral suppression. Setting: Large tertiary care health system in the Bronx, NY, USA. Methods: We conducted a retrospective cohort study of 4613 SARS-CoV-2 PCR-positive patients admitted between March 10, 2020, and May 11, 2020. We examined in-hospital intubation, acute kidney injury (AKI), hospitalization length, and in-hospital mortality by HIV serostatus, and by HIV-viral suppression and CD4 counts among people living with HIV (PLWH) using adjusted competing risks regression. We also compared immune and inflammatory marker levels by HIV serostatus and viral suppression. Results: Most patients were either non-Hispanic Black (36%) or Hispanic (37%); 100/4613 (2.2%) were PLWH, among whom 15 had detectable HIV viral load. PLWH compared to patients without HIV had increased intubation rates (adjusted hazard ratio 1.73 [95% CI: 1.12 to 2.67], P = 0.01). Both groups had similar rates of AKI, length of hospitalization, and death. No (0%) virally unsuppressed PLWH were intubated or died, versus 21/81 (26%, P = 0.04) and 22/81 (27%, P = 0.02) of virally suppressed PLWH, respectively. Among PLWH, higher CD4 T-cell counts were associated with increased intubation rates. C-reactive protein, IL-6, neutrophil counts, and ferritin levels were similar between virally suppressed PLWH and patients without HIV, but significantly lower for unsuppressed PLWH (all P < 0.05). Conclusions: PLWH had increased risk of intubation but similarly frequent rates of AKI and in-hospital death as those without HIV. Findings of no intubations or deaths among PLWH with unsuppressed HIV viral load warrant further investigation.

COVID-19 Disease Severity among People with HIV Infection or Solid Organ Transplant in the United States: A Nationally-representative, Multicenter, Observational Cohort Study

“…Whether PWH have elevated risk of severe COVID-19 disease has been under debate, and previous studies provided conflicting evidence on the association of HIV infection with COVID-19 severity 9,15,16,[24][25][26][27][28] . Our results add to a growing body of evidence 13,[28][29][30][31] suggesting that PWH, indeed, have an independent increased risk for severe COVID-19 compared to the general population.…”

HIV and SARS-CoV-2 Co-Infection: What are the Risks?

“…Patel et al 16 conducted a retrospective cohort study on 4613 COVID-19 positive patients; 100 were PLWH. In an analysis adjusted for age, sex, race/ethnicity, BMI, history of chronic lower respiratory diseases and calendar time, PLWH had an increased risk of intubation compared to PNLWH (aHR 1.73, 95% CI 1.12–2.67; p= 0.01).…”

SARS-CoV-2 Portrayed Against HIV: Contrary Viral Strategies in Similar Disguise

“…SARS-CoV-2 and HIV-1 co-infection and mutual impact Data on the mutual impact of SARS-CoV-2 and HIV-1 co-infections is still unfolding. Early during the COVID-19 pandemic, mixed and partly contrasting results from clinical studies were reported, mainly based on differences in cohort composition, limited co-infection cases per study, and confounding factors, including differences in applied or absent ART [508][509][510]. While an immunocompromised status has been considered a general risk factor for COVID-19, it remained elusive whether the resulting decreased detrimental inflammatory response might even confer beneficial effects and mitigate clinical symptomatic [511][512][513][514][515].…”