New HIV diagnoses in patients with COVID-19: two case reports and a brief literature review

Zhang, Jiu-Cong; Yu, Xiaohui; Ding, Xiaoyan; Ma, Haoyu; Xiao, Chengwen; Kang, Shengchao; Xiang, Dawei

doi:10.1186/s12879-020-05480-y

Cited by 13 publications

(18 citation statements)

References 27 publications

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“…One patient was screened after an employee's needlestick injury. New diagnosis of HIV at the time of COVID-19 diagnosis is not commonly reported at this time but brings forward the importance of considering additional diagnoses in patients with COVID-19 that are critically ill 22 and to emphasize the need for universal offering of HIV testing at the time of hospital admission.…”

Section: Discussionmentioning

confidence: 99%

A comparison of COVID-19 inpatients by HIV status

et al. 2021

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COVID-19 in-hospital morbidity and mortality in people living with HIV (PLWH) were compared to HIV-negative COVID-19 patients within a New York City metropolitan health system, the hardest hit region in the United States early in the pandemic. A total of 10,202 inpatients were diagnosed with COVID-19, of which 99 were PLWH. PLWH were younger (58.3 years (SD = 12.42) versus 64.32 years (SD = 16.77), p < 0.001) and had a higher prevalence of men (73.7% versus 57.9%, p = 0.002) and Blacks (43.4% versus 21.7%, p < 0.001) than the HIV-negative population. PLWH had a higher prevalence of malignancies (18% versus 7%, p = < 0.001), chronic liver disease (12% versus 3%, p < 0.001), and end-stage renal disease (11% versus 4%, p = 0.007). Use of a ventilator, admission to the ICU, and in-hospital mortality were not different. Of the 99 PLWH, 12 were virally unsuppressed and 9 had CD4% < 14. Two of the 12 virally unsuppressed patients and 4/9 patients with CD4% < 14 died. Ninety-one of the 99 PLWH were on treatment for HIV, and 5 of the 8 not on treatment died. Among PLWH with prior values, absolute CD4 count decreased an average of 192 cells/mm3 at the time of COVID-19 diagnosis ( p < 0.001). Hospitalized patients with HIV and COVID-19 coinfection did not have worse outcomes than the general population. Among PLWH, those with CD4%<14 or not on treatment for HIV had higher mortality rates. Those PLWH who received IL-6 inhibitors had lower mortality rates. PLWH given antifungal medications, hydroxychloroquine, antibiotics (including azithromycin), steroids, and vasopressors had higher mortality rates.

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Section: Discussionmentioning

confidence: 99%

A comparison of COVID-19 inpatients by HIV status

et al. 2021

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“…However, sequential changes in blood counts were not documented in most studies on PLHIV with COVID-19. In this review, we found only three studies which reported changes in full blood counts [ 55 , 81 , 102 ]; however, all three reported cell counts within the normal range on admission and throughout hospitalization. While this may be the case, it is not unreasonable to expect that PLHIV will demonstrate a blood cell profile largely similar to that of non-HIV infected people as a response to the infection.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 in People Living with HIV: A Systematic Review and Meta-Analysis

Lee

Yap

Ngeow

et al. 2021

IJERPH

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COVID-19 is a global health emergency. People living with human immunodeficiency virus (PLHIV) have concerns about whether they have a higher risk of getting the infection and suffer worse COVID-19 outcomes. Findings from studies on these questions have largely been inconsistent. We aimed to determine the epidemiological characteristics, clinical signs and symptoms, blood parameters, and clinical outcomes among PLHIV who contracted COVID-19. Relevant studies were identified through Medline, Cinahl, and PubMed databases. A random-effects model was used in meta-analyses with a 95% confidence interval. Eighty-two studies were included in the systematic review and sixty-seven studies for the meta-analysis. The pooled incidence proportion of COVID-19 among PLHIV was 0.9% (95% CI 0.6%, 1.1%) based on the data from seven cohort studies. Overall, 28.4% were hospitalised, of whom, 2.5% was severe-critical cases and 3.5% needed intensive care. The overall mortality rate was 5.3%. Hypertension was the most commonly reported comorbidity (24.0%). Fever (71.1%) was the most common symptom. Chest imaging demonstrated a wide range of abnormal findings encompassing common changes such as ground glass opacities and consolidation as well as a spectrum of less common abnormalities. Laboratory testing of inflammation markers showed that C-reactive protein, ferritin, and interleukin-6 were frequently elevated, albeit to different extents. Clinical features as well as the results of chest imaging and laboratory testing were similar in highly active antiretroviral therapy (HAART)-treated and non-treated patients. PLHIV were not found to be at higher risk for adverse outcomes of COVID-19. Hence, in COVID-19 management, it appears that they can be treated the same way as HIV negative individuals. Nevertheless, as the pandemic situation is rapidly evolving, more evidence may be needed to arrive at definitive recommendations.

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“…77% of the patients in this series had at least one co-morbid condition, increasing their risk for worse outcomes. The first diagnosis of HIV in a patient with AIDS at the time of ICU admission for COVID-19 (also previously reported) [ 22 , 23 ] makes a compelling case for routine HIV screening on all patients hospitalized with severe or critical COVID-19.…”

Section: Discussionmentioning

confidence: 95%

“…It is unclear whether PWH have increased risk for secondary infections or other adverse events after the use of IL-6ri for severe COVID-19. There are few reports of PWH receiving IL-6ri for COVID-19 [ 22 , 23 ]. Here, we present 4 narrative case reports accompanied by a description of the outcomes of 18 patients with a diagnosis of HIV and PCR-confirmed COVID-19 treated with IL-6ri between April and June 2020.…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes after IL-6 blockade in patients with COVID-19 and HIV: a case series

et al. 2022

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Background In hospitalized people with HIV (PWH) there is an increased risk of mortality from COVID-19 among hospitalized PWH as compared to HIV-negative individuals. Evidence suggests that tocilizumab—a humanized monoclonal interleukin (IL)-6 receptor inhibitor (IL-6ri) antibody—has a modest mortality benefit when combined with corticosteroids in select hospitalized COVID-19 patients who are severely ill. Data on clinical outcomes after tocilizumab use in PWH with severe COVID-19 are lacking. Case presentation We present a multinational case series of 18 PWH with COVID-19 who were treated with IL-6ri’s during the period from April to June 2020. Four patients received tocilizumab, six sarilumab, and eight received an undocumented IL-6ri. Of the 18 patients in the series, 4 (22%) had CD4 counts < 200 cells/mm3; 14 (82%) had a suppressed HIV viral load. Eight patients (44%), all admitted to ICU, were treated for secondary infection; 5 had a confirmed organism. Of the four patients with CD4 counts < 200 cells/mm3, three were treated for secondary infection, with 2 confirmed organisms. Overall outcomes were poor—12 patients (67%) were admitted to the ICU, 11 (61%) required mechanical ventilation, and 7 (39%) died. Conclusions In this case series of hospitalized PWH with COVID-19 and given IL-6ri prior to the common use of corticosteroids, there are reports of secondary or co-infection in severely ill patients. Comprehensive studies in PWH, particularly with CD4 counts < 200 cells, are warranted to assess infectious and other outcomes after IL-6ri use, particularly in the context of co-administered corticosteroids.

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New HIV diagnoses in patients with COVID-19: two case reports and a brief literature review

Cited by 13 publications

References 27 publications

A comparison of COVID-19 inpatients by HIV status

A comparison of COVID-19 inpatients by HIV status

COVID-19 in People Living with HIV: A Systematic Review and Meta-Analysis

Clinical outcomes after IL-6 blockade in patients with COVID-19 and HIV: a case series

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