COVID-19 severity and in-hospital mortality in an area with high HIV prevalence

Abstract

Background: HIV infection causes immune dysregulation affecting T-cell and monocyte function, which may alter coronavirus disease 2019 (COVID-19) pathophysiology.Objectives: We investigated the associations among clinical phenotypes, laboratory biomarkers, and hospitalisation outcomes in a cohort of people hospitalised with COVID-19 in a high HIV prevalence area.Method: We conducted a prospective observational cohort study in Tshwane, South Africa. Respiratory disease severity was quantified using the respiratory oxygenation score. Analysed biomarkers included inflammatory and coagulation biomarkers, CD4 T-cell counts, and HIV-1 viral loads (HIVVL).Results: The analysis included 558 patients, of whom 21.7% died during admission. The mean age was 54 years. A total of 82 participants were HIV-positive. People living with HIV (PLWH) were younger (mean age 46 years) than HIV-negative people; most were on antiretroviral treatment with a suppressed HIVVL (72%) and the median CD4 count was 159 (interquartile range: 66–397) cells/µL. After adjusting for age, HIV was not associated with increased risk of mortality during hospitalisation (age-adjusted hazard ratio = 1.1, 95% confidence interval: 0.6–2.0). Inflammatory biomarker levels were similar in PLWH and HIV-negative patients. Detectable HIVVL was associated with less severe respiratory disease. In PLWH, mortality was associated with higher levels of inflammatory biomarkers. Opportunistic infections, and other risk factors for severe COVID-19, were common in PLWH who died.Conclusion: PLWH were not at increased risk of mortality and those with detectable HIVVL had less severe respiratory disease than those with suppressed HIVVL.What this study adds: This study advances our understanding of severe COVID-19 in PLWH.

Characteristic and Outcomes of PLWH Hospitalized with COVID-19 Coinfection: A Literature Review Study

“…Additionally, research conducted by (Shapiro et al, 2022) found an independent association between a CD4 count <350 cells/mm³, a lower nadir CD4 (<200 cells/mm³), and a lower CD4/CD8 ratio with the rate of hospitalization. Another study reported that markers of disease severity in PLHIV hospitalized with COVID-19 were stratified by CD4 count and HIV-1 viral load, with a CD4 count below 200 cells/µL being associated with greater disease severity (Boswell et al, 2023). (Ming Jie Lee et al, 2021) also found that the median CD4 count of patients was 352 cells/mm³.…”

Are persons living with diagnosed HIV capable of mounting a strong inflammatory response to the new coronavirus?

“…Inflammatory biomarker levels were similar in PLWH and HIV-negative patients. 22 In our cohort we attempted to better understand the immune system reaction to COVID-19 in PLWDH. This study assessed the prevalence of elevated clinical laboratory inflammatory markers among PLWDH in NYS who were hospitalized with COVID-19 during the first wave of COVID-19 pandemic and compared those to matched controls without HIV diagnosis who were hospitalized with COVID-19 infection.…”