Impact of SARS-CoV-2 infection in patients with hereditary hemorrhagic telangiectasia: epidemiological and clinical data from the comprehensive Italian retrospective multicenter study

Abstract

Rare Disease patients manifested high concern regarding the possible increased risk of severe outcomes and worsening of disease-specific clinical manifestation due to the impact of COVID-19. Our aim was to assess the prevalence, outcomes, and impact of COVID-19 in patients with a rare disease such as Hereditary Hemorrhagic Telangiectasia (HHT) in Italian population. A nationwide, multicentric, cross-sectional observational study was conducted on patients with HHT from five Italian HHT centers by online survey. The association between COVID-19-related signs and symptoms and nosebleeds worsening, the impact of personal protective equipment on nosebleeds pattern, and the relationship between the presence of visceral AVMs and severe outcomes were analyzed. Out of 605 total survey responses and eligible for analysis, 107 cases of COVID-19 were reported. A mild-course COVID-19 disease, not requiring hospitalization, was observed in 90.7% of patients, while the remaining eight cases needed hospitalization, two of them requiring intensive-care access. No fatal outcome was recorded and 79.3% of patients reported a complete recovery. No difference in infection risk and outcome between HHT patients and general population was evidenced. No significative interference of COVID-19 on HHT-related bleeding was found. The majority of patients received COVID-19 vaccination, with relevant impact on symptoms and need for hospitalization in case of infection. COVID-19 in HHT patients had an infection profile similar to the general population. COVID-19 course and outcome were independent from any specific HHT-related clinical features. Moreover, COVID-19 and anti-SARS-CoV-2 measures did not seem to affect significantly HHT-related bleeding profile.

Impact of the COVID-19 Pandemic on People Living With Rare Diseases and Their Families: Results of a National Survey

“…Respondents who acquired the infection described a mild disease, with few requiring hospitalization or critical care and only 1 death reported. A mild course of COVID-19 infections has been reported among patients with hereditary hemorrhagic telangiectasia in Italy [50], rare endocrine diseases in a European registry study [38], lysosomal storage diseases in London [79], and Gaucher disease in New York [42]; in a large group of patients with RD in Brazil [43]; and among people with myasthenia gravis in a subanalysis of this survey [52]. These reassuring findings are in contrast with higher COVID-19-related mortality among patients with RD in Hong Kong hospitals compared with in-patients from the general population [37] and people with neurological and neurodevelopmental diseases in a Genomics England cohort study [33].…”