Hospitalized Patients With COVID-19 and Human Immunodeficiency Virus: A Case Series

Childs, Kate; Post, Frank A.; Norcross, Claire; Ottaway, Zoë; Hamlyn, Elizabeth; Quinn, Killian; Juniper, Thomas; Taylor, Chris

doi:10.1093/cid/ciaa657

Cited by 79 publications

(97 citation statements)

References 4 publications

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“…Early data from small cohorts and case series in other countries included a high proportion of patients experiencing severe disease. [22][23][24] A single-centre cohort in Madrid found that among 51 people living with HIV and diagnosed with COVID-19, 28 required hospital admission, and 13 had severe disease; the mortality rate among COVID-19 cases co-infected with HIV in this study was noted to be around double that in similar aged individuals in the general population. 9 Associations between HIV and adverse COVID-19 outcomes appear to be smaller among patients already hospitalised with COVID-19: the HR for mortality was attenuated to 1.45 (1.14-1.84) in the Western Cape study when restricted to hospitalised patients, 8 while an analysis of patients hospitalised in New York found no difference in adverse outcomes between HIV infected and demographically similar uninfected individuals.…”

Section: Comparison With Other Evidencementioning

confidence: 50%

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

Bhaskaran

Rentsch

MacKenna

et al. 2020

Preprint

119

152

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Background: It is unclear whether HIV infection is associated with risk of COVID-19 death. We aimed to investigate this in a large-scale population-based study in England. Methods: Working on behalf of NHS England, we used the OpenSAFELY platform to analyse routinely collected electronic primary care data linked to national death registrations. People with a primary care record for HIV infection were compared to people without HIV. COVID-19 death was defined by ICD-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, initially adjusted for age and sex, then adding adjustment for index of multiple deprivation and ethnicity, and finally for a broad range of comorbidities. Interaction terms were added to assess effect modification by age, sex, ethnicity, comorbidities and calendar time. Results: 17.3 million 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. There were 14,882 COVID-19 deaths during the study period, with 25 among people with HIV. People living with HIV had nearly three-fold higher risk of COVID-19 death than those without HIV after adjusting for age and sex (HR=2.90, 95% CI 1.96-4.30). The association was attenuated but risk remained substantially raised, after adjustment for deprivation and ethnicity (adjusted HR=2.52, 1.70-3.73) and further adjustment for comorbidities (HR=2.30, 1.55-3.41). There was some evidence that the association was larger among people of black ethnicity (HR = 3.80, 2.15-6.74, compared to 1.64, 0.92-2.90 in non-black individuals, p-interaction=0.045) Interpretation: HIV infection was associated with a markedly raised risk of COVID-19 death in a country with high levels of antiretroviral therapy coverage and viral suppression; the association was larger in people of black ethnicity.

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Section: Comparison With Other Evidencementioning

confidence: 50%

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

Bhaskaran

Rentsch

MacKenna

et al. 2020

Preprint

119

152

View full text Add to dashboard Cite

show abstract

“…We identified 1,908 records and included 19 studies in our final qualitative analysis ( Figure 1). Seventeen studies [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] were peer-reviewed and two were preprints [27,28]. Quality appraisal is included in Tables 1, S2 and S3.…”

Section: Summary Of Included Studiesmentioning

confidence: 99%

“…CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint and/or PLWH without COVID-19, [11,12,14,15,23,25,26], two studies compared only to a HIV-negative cohort [13,19], two studies compared only cohorts of PLWH with and without COVID-19 [17,22] and three studies compared only the characteristics of PLWH with different COVID-19 disease severity [20,21,24].…”

Section: Summary Of Included Studiesmentioning

confidence: 99%

“…A US hospital study found that PLWH and COVID-19 who survived were more likely to have been treated with NRTIs that those PLWH who died (99% vs 89%, p=0.04) in univariate analysis [13]. Seven smaller studies (n=18-93 PLWH with COVID- 19) reported no significant association between ART-regimen and COVID-19 severity amongst PLWH [14,15,17,[20][21][22][23][24].…”

Section: Impact Of Art Regimen On Covid-19 Outcomesmentioning

confidence: 99%

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Risk of adverse COVID-19 outcomes for people living with HIV: a rapid review and meta-analysis

Mellor

Bast

Jones

et al. 2020

Preprint

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Objective: To assess whether people living with HIV (PLWH) are at increased risk of COVID-19 mortality or adverse outcomes, and whether antiretroviral therapy (ART) influences this risk. Design: Rapid review with meta-analysis and narrative synthesis. Methods: We searched databases including Embase, Medline, medRxiv, and Google Scholar up to 26th August 2020 for studies describing COVID-19 outcomes in PLWH and conducted a meta-analysis of higher quality studies. Results: We identified 1,908 studies and included 19 in the review. In a meta-analysis of five studies, PLWH had a higher risk of COVID-19 mortality (hazard ratio (HR) 1.93, 95% Confidence Interval (CI): 1.59-2.34) compared to people without HIV. Risk of death remained elevated for PLWH in a subgroup analysis of hospitalised cohorts (HR 1.54, 95% CI: 1.05-2.24) and studies of PLWH across all settings (HR 2.08, 95%CI: 1.69-2.56). Eight other studies assessed the association between HIV and COVID-19 outcomes, but provided inconclusive, lower-quality evidence due to potential confounding and selection bias. There were insufficient data on the effect of CD4+ T cell count and HIV viral load on COVID-19 outcomes. Eleven studies reported COVID-19 outcomes by ART-regimen. In the two largest studies, tenofovir-disoproxil-fumarate (TDF)-based regimens were associated with a lower risk of adverse COVID-19 outcomes, although these analyses are susceptible to confounding by comorbidities. Conclusion: Evidence is emerging that suggests a moderately increased risk of COVID-19 mortality amongst PLWH. Further investigation into the relationship between COVID-19 outcomes and CD4+ T cell count, HIV viral load, ART and the use of TDF is warranted.

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“…The incidence and course of COVID-19 disease due to SARS-CoV-2 in people living with HIV (PLWH) is uncertain, with little current evidence to suggest worse outcomes. [1][2][3] We report 18 PLWH, admitted to hospital with COVID-19 between March and April 2020. The majority (16/18) had positive PCR swabs for SARS-CoV-2, and two had negative swabs and no other respiratory pathogens isolated with typical COVID-19 imaging and history.…”

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confidence: 99%

Descriptive account of 18 adults with known HIV infection hospitalised with SARS-CoV-2 infection

et al. 2020

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ObjectiveTo report on the clinical characteristics and outcome of 18 people living with HIV (PLWH) hospitalised with SARS-CoV-2 infection in a London teaching hospital.MethodsThe hospital notes of 18 PLWH hospitalised with SARS-CoV-2 infection were retrospectively reviewed alongside data concerning their HIV demographics from an established HIV Database.ResultsThe majority (16/18) had positive PCR swabs for SARS-CoV-2, and two had negative swabs but typical COVID-19 imaging and history. Most were male (14/18, 78%), median age 63 years (range 47–77 years). Two-thirds were migrants, nine (50%) of Black, Asian and minority ethnicity (BAME). All were diagnosed with HIV for many years (range 8–31 years), and all had an undetectable HIV viral load (<40 copies/mL). The median CD4 prior to admission was 439 (IQR 239–651), and 10/16 (63%) had a CD4 nadir below 200 cells/mm3. Almost all (17/18) had been diagnosed with at least one comorbidity associated with SARS-CoV-2 prior to admission. 3/18 patients died. None received mechanical ventilation. Hospital stay and clinical course did not appear prolonged (median 9 days).ConclusionsOur data suggest that PLWH may not necessarily have prolonged or complex admissions to hospital when compared with the general hospital and national population admitted with COVID-19. Many had low nadir CD4 counts and potentially impaired functional immune restoration. The PLWH group was younger than generally reported for COVID-19, and the majority were male with multiple complex comorbidities. These patients had frequent contact with hospital settings increasing potential for nosocomial acquisition and increased risk of severe COVID-19.

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Hospitalized Patients With COVID-19 and Human Immunodeficiency Virus: A Case Series

Cited by 79 publications

References 4 publications

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

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

Risk of adverse COVID-19 outcomes for people living with HIV: a rapid review and meta-analysis

Descriptive account of 18 adults with known HIV infection hospitalised with SARS-CoV-2 infection

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