Predictors of in-hospital mortality in HIV-infected patients with COVID-19

Abstract

Background Underlying immunodeficiency is associated with severe COVID-19, but the prognosis of persons with HIV (PWH) with COVID-19 is under debate. Methods Nationwide, retrospective, observational analysis of all hospitalizations with COVID-19 during year 2020 in Spain. Stratification was made according to HIV status. The National Registry of Hospital Discharges was used with the ICD-10 coding list. Results A total of 117,694 adults were hospitalized with COVID-19 during 2020. Only 234 (0.2%) were HIV-positives. More than 95% were on antiretroviral therapy. Compared to HIV-negatives, PWH were younger (mean age 53.2 vs 66.5 years-old; p < 0.001) and more frequently male (74.8% vs 56.6%; p < 0.001). Most co-morbidities predisposing to severe COVID-19 (diabetes, hypertension, dementia, cardiovascular disease) were more frequent in HIV-negatives. In contrast, the rate of baseline liver disease was over 6-fold higher in PWH (27.4% vs 4.4%; p < 0.001). In-hospital mortality was lower in PWH (9.4% vs 16%; p = 0.004). In multivariate analysis, older age, dementia and especially advanced liver disease (RR: 7.6) were the major determinants of death in PWH hospitalized with COVID-19. Conclusion HIV-infected patients hospitalized in Spain with COVID-19 during 2020 had better survival than HIV-negatives, most likely explained by younger age and lower rate of co-morbidities. However, advanced liver disease was a major predictor of death in PWH hospitalized with COVID-19.

Empiric Antibiotics in COVID-19 Patients: To Give or Not to Give*

“…The prevalence of bacterial coinfection and superinfection during a COVID-19 infection is different than what we have experienced with prior viral pandemics (2)(3)(4). The majority of the current studies report a low prevalence of bacterial coinfection in hospitalized COVID-19 patients, ranging from 3.1% to 8.5%.…”

The impact of COVID-19 pandemic on healthcare associated infections: A teaching hospital experience

“…In this study, microbiological tests confirmed that about 1 quarter of COVID-19 patients had a 3-fold increase in bacterial infections compared to the results of other international studies. [16,17]…”

“…In this study, microbiological tests confirmed that about 1 quarter of COVID-19 patients had a 3-fold increase in bacterial infections compared to the results of other international studies. [16,17] A high prevalence of infection was secondary in 91% of cases, while the number of co-infections was rare. This is compatible with other studies where the prevalence was 3.5 and 14.3% for co-and secondary infections respectively.…”

Incidence and risk factors for clinically confirmed secondary bacterial infections in patients hospitalized for coronavirus disease 2019 (COVID-19)

“…16,17 Baseline use of immunosuppressive medications have also been reported with an increased likelihood of secondary infection. 21 Finally, patients transferred from an outside facility were likely due to more severe COVID-19 because our institution serves as a referral center for the state of Oregon.…”