COVID-19 death in people with HIV: interpret cautiously

Waters, Laura; Pozniak, Anton

doi:10.1016/s2352-3018(20)30332-5

Cited by 26 publications

(21 citation statements)

References 5 publications

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“…People with HIV have a greater risk for fatal outcome upon COVID-19-related admission to hospital 8 with higher associations in people of Black ethnicity than in non-Black individuals. 23 In South Africa, HIV infection has also been associated with an increased risk of death from COVID-19, irrespective of HIV-1 viral load and immunosuppression.…”

Section: Discussionmentioning

confidence: 99%

“… 6 Compared with HIV-negative individuals, people with HIV are at greater risk for infectious diseases, such as influenza, including during antiretroviral therapy (ART), 7 and are at higher risk of a fatal outcome when admitted to hospital for severe COVID-19. 8 Risk factors for severe COVID-19 in people with HIV include more advanced stage of HIV/AIDS, the HIV-1 infection not being virally suppressed, and CD4 counts below 500 cells per μL.…”

Section: Introductionmentioning

confidence: 99%

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Safety and immunogenicity of the ChAdOx1 nCoV-19 (AZD1222) vaccine against SARS-CoV-2 in people living with and without HIV in South Africa: an interim analysis of a randomised, double-blind, placebo-controlled, phase 1B/2A trial

Madhi¹,

Koen²,

Izu³

et al. 2021

The Lancet HIV

145

146

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Background People living with HIV are at an increased risk of fatal outcome when admitted to hospital for severe COVID-19 compared with HIV-negative individuals. We aimed to assess safety and immunogenicity of the ChAdOx1 nCoV-19 (AZD1222) vaccine in people with HIV and HIV-negative individuals in South Africa. Methods In this ongoing, double-blind, placebo-controlled, phase 1B/2A trial (COV005), people with HIV and HIV-negative participants aged 18–65 years were enrolled at seven South African locations and were randomly allocated (1:1) with full allocation concealment to receive a prime-boost regimen of ChAdOx1 nCoV-19, with two doses given 28 days apart. Eligibility criteria for people with HIV included being on antiretroviral therapy for at least 3 months, with a plasma HIV viral load of less than 1000 copies per mL. In this interim analysis, safety and reactogenicity was assessed in all individuals who received at least one dose of ChAdOx1 nCov 19 between enrolment and Jan 15, 2021. Primary immunogenicity analyses included participants who received two doses of trial intervention and were SARS-CoV-2 seronegative at baseline. This trial is registered with ClinicalTrials.gov, NCT04444674, and the Pan African Clinicals Trials Registry, PACTR202006922165132. Findings Between June 24 and Nov 12, 2020, 104 people with HIV and 70 HIV-negative individuals were enrolled. 102 people with HIV (52 vaccine; 50 placebo) and 56 HIV-negative participants (28 vaccine; 28 placebo) received the priming dose, 100 people with HIV (51 vaccine; 49 placebo) and 46 HIV-negative participants (24 vaccine; 22 placebo) received two doses (priming and booster). In participants seronegative for SARS-CoV-2 at baseline, there were 164 adverse events in those with HIV (86 vaccine; 78 placebo) and 237 in HIV-negative participants (95 vaccine; 142 placebo). Of seven serious adverse events, one severe fever in a HIV-negative participant was definitely related to trial intervention and one severely elevated alanine aminotranferase in a participant with HIV was unlikely related; five others were deemed unrelated. One person with HIV died (unlikely related). People with HIV and HIV-negative participants showed vaccine-induced serum IgG responses against wild-type Wuhan-1 Asp614Gly (also known as D614G). For participants seronegative for SARS-CoV-2 antigens at baseline, full-length spike geometric mean concentration (GMC) at day 28 was 163·7 binding antibody units (BAU)/mL (95% CI 89·9–298·1) for people with HIV (n=36) and 112·3 BAU/mL (61·7–204·4) for HIV-negative participants (n=23), with a rising day 42 GMC booster response in both groups. Baseline SARS-CoV-2 seropositive people with HIV demonstrated higher antibody responses after each vaccine dose than did people with HIV who were seronegative at baseline. High-level binding antibody cross-reactivity for the full-length spike and receptor-binding domain of the beta variant (B.1.351) was seen regardless of HIV status. ...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Safety and immunogenicity of the ChAdOx1 nCoV-19 (AZD1222) vaccine against SARS-CoV-2 in people living with and without HIV in South Africa: an interim analysis of a randomised, double-blind, placebo-controlled, phase 1B/2A trial

Madhi¹,

Koen²,

Izu³

et al. 2021

The Lancet HIV

145

146

View full text Add to dashboard Cite

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“…In addition, the UK sample had an under-representation of HIV cases in the epicenter (e.g., London). 3 In contrast, in the South African study, the HIV-associated risk of COVID-19 death may be overestimated due to the under-ascertainment of some comorbidities and the lack of other residual confounding (e.g., BMI). 12 It is noteworthy that the association in the present study was similar to a New York state-level setting involving 2,988 PLWH with COVID-19 (in-hospital death: sRR: 1.23; 95%CI: 1.07-1.40) 15 , although limitations this study included a lack of control for lifestyle factors and comorbidity data, and a short observation period (March 1-June 7, 2020).…”

Section: Discussionmentioning

confidence: 89%

“…Older age and presence of comorbidities are recognized to increase the severity of COVID-19. 2 Patients who have malignant disease or solid-organ transplants have overall poorer outcomes of COVID-19, 3 but the evidence is less clear for people with other types of immunocompromising conditions, including people living with HIV (PLWH). 4…”

Section: Introductionmentioning

confidence: 99%

The role of HIV infection in the clinical spectrum of COVID-19: a population-based cohort analysis based on US National COVID Cohort Collaborative (N3C) Enclave data

Yang

Zhang

Guo

et al. 2021

Preprint

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Background Evidence of whether people living with HIV (PLWH) are at elevated risk of adverse COVID-19 outcomes is limited. We aimed to investigate this association using the population-based National COVID Cohort Collaborative (N3C) data in the US. Methods The harmonized, high-granularity electronic health record data from 54 clinical sites in N3C were used for this study. Logistic and multinomial logistic regression models were employed to estimate the association between HIV infection and hospitalization, mortality, and clinical severity of COVID-19, with models being initially adjusted for age and sex, then cumulatively adjusted for race and ethnicity, smoking and obesity, and a broad range of comorbidities. Interaction terms were added to assess the modification effect by age, sex, and race. Findings Among a total of 1,436,622 adult COVID-19 cases between January 2020 and May 2021, 13,170 had HIV infection. A total of 26,130 deaths occurred, with 445 among PLWH. PLWH had a higher risk of COVID-19 death and hospitalization than non-PLWH after adjusting for age and sex. The associations were attenuated, but remained significant, after adjusting for lifestyle factors and comorbidities (COVID-19 death: [adjusted OR(AOR): 1.38; 95%CI: 1.25-1.54]; hospitalization: [AOR: 1.23; 95%CI: 1.18-1.28]). In terms of COVID-19 disease severity, PLWH were less likely to have mild/moderate illness but more likely to have a severe illness when only controlling for demographics, smoking and BMI, although the estimated risk was obviated after controlling for comorbidities. Interaction terms revealed that the elevated risk was higher among the older age group, males, and black/African American. Interpretation PLWH in the US had an increased risk of COVID-19 hospitalization and mortality comparing with non-PLWH. The adverse COVID-19 outcomes might not only be accounted for by HIV but also by other risk factors that are highly prevalent in PLWH. Funding National Center for Advancing Translational Sciences, National Institute of Allergy And Infectious Diseases, US

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“…However, it is important to note that due to the quickly changing testing procedures and requirements for hospitalization throughout the pandemic, as well as the reliance on public health surveillance data and/or medical record review, the ability to truly distinguish severity of outcomes in PWH is difficult and often confounded. 148 Regardless, preventive measures for PWH should be strongly encouraged (particularly vaccination) to limit disease severity.…”

Section: Discussionmentioning

confidence: 99%