Long‐coronavirus disease among people living with HIV in western India: An observational study

Abstract

Background Long‐COVID is emerging as a significant problem among individuals who recovered from COVID‐19. Scant information is available on the prevalence, characteristics, and risk factors for long‐COVID among people living with HIV (PLHIV). Setting A tertiary level, private, HIV clinic in western India. Methods A prospective, observational study was conducted to assess the prevalence of long‐COVID among PLHIV. Long‐COVID was defined as the presence of at least one symptom after 30 days of illness onset. A questionnaire for assessing general, cardiorespiratory, neuro‐psychiatric, and gastro‐intestinal symptoms was used to screen individuals with history of confirmed COVID‐19. Data on demographics, HIV‐related variables, comorbidities, and severity of COVID‐19 were abstracted from electronic medical records. Univariate and multivariate logistic regression were used to identify risk factors for long‐COVID. Results Ninety‐four PLHIV were screened for long‐COVID. Median (interquartile range [IQR]) age was 51 (47–56) years and 73.4% were males. The majority (76.6%) had a history of asymptomatic–mild COVID‐19 illness. The prevalence of long‐COVID was 43.6% (95% confidence interval [CI], 33.4–54.2). Moderate–severe COVID‐19 illness was significantly associated with long‐COVID (adjusted odds ratio, 4.7; 95% CI, 1.4–17.9; p = .016). Among individuals with long‐COVID, cough (22.3%) and fatigue (19.1%) were the commonest symptoms. The median (IQR) duration for resolution of symptoms was 15 (7–30) days. Ten individuals (10.6%) had persistent symptoms at a median of 109 days since the onset of COVID‐19. Conclusion Long‐COVID is common among PLHIV with moderate–severe acute COVID‐19 illness. There is a need for integration of long‐COVID diagnosis and care services within antiretroviral therapy clinics for PLHIV with COVID‐19.

Post-Acute Sequelae and Adaptive Immune Responses in People Living With Hiv Recovering From Sars-Cov-2 Infection

“…There are limited data on PASC among PWH [55], however. One single-center study suggested that acute illness severity in PWH was significantly associated with PASC with 44% of participants experiencing at least one symptom 30 days after recovery [40], however it did not find an association between clinical parameters such as CD4+ T cell count, viral load, demographics or comorbidities and the presence of PASC, and did not compare PWH with HIV-negative individuals. Another retrospective study suggested that HIV was one factor that was associated with higher risk of PASC approximately one year after COVID-19 diagnosis among those requiring emergency department or hospital-based care [56], but the analysis was limited to 10 PWH and did not include biological measurements.…”

“…While there are massive efforts underway to understand the prevalence and pathophysiology of PASC, there are limited data among PWH [30]. One single-center study suggested that acute illness severity in PWH was associated with PASC with 44% of participants experiencing at least one symptom 30 days after recovery [31], however it did not find an association with CD4+ T cell count, viral load, demographics or comorbidities, and did not compare PWH with HIV-negative individuals.…”

“…Higher prevalence of such factors among PWH [31,32], along with differences in immune responses to SARS-CoV-2 [14,15] and chronic inflammation and immune dysregulation even in the presence of antiretroviral therapy [33][34][35][36][37][38][39], may make PWH selectively vulnerable to developing persistent COVID-19-attributed symptoms following SARS-CoV-2 infection. For these reasons, examination of PASC in PWH is urgently needed [40].…”

HIV and COVID-19: review of clinical course and outcomes

“…63 To the best of our knowledge, thus far only one study has investigated the risk of post-acute symptoms following COVID-19 and found that moderate to severe disease was associated with an increased risk of persistent symptoms in PWH. 95 …”

COVID-19 in the Immunocompromised Host, Including People with Human Immunodeficiency Virus

“…One small study characterized PASC in an Indian cohort of 94 PWH, finding a PASC prevalence of 43.6% and increased risk among persons who had had moderate-severe COVID-19 compared to mild disease. 40 There is an urgent need to more broadly characterize risk and manifestations of PASC, including the relationship between immunosuppression and incidence of PASC, in PWH in larger, more diverse global cohorts. This information is critical to guide post-COVID HIV care, to understand potential interactions between HIV and COVID, and to inform interventional strategies to prevent and treat PASC in PWH.…”