SARS‐CoV‐2 infection in persons living with HIV: A single center prospective cohort

Maggiolo, Franco; Zoboli, Fabio; Arosio, Marco; Valenti, Daniela; Guarneri, Davide; Sangiorgio, Lorena; Ripamonti, Diego; Callegaro, Annapaola

doi:10.1002/jmv.26352

Cited by 37 publications

(40 citation statements)

References 16 publications

(57 reference statements)

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“…In any case, data presented herein are in line with the greater clinical severity of this disease among HIV-infected patients suggested by studies conducted in South Africa 8 or in Italy 21 .…”

Section: Discussionsupporting

confidence: 89%

Incidence of COVID-19 among people living with HIV in Southern Spain

Fernández‐Fuertes¹,

Rodriguez-Pineda²,

Fuentes-López³

et al. 2020

Preprint

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Objective and Design: The incidence of SARS-CoV-2 infection among people living with HIV (PLWH) has been estimated on the basis of reported symptomatic clinical cases. However, as asymptomatic cases are common and there have been limitations of health care systems for COVID-19 microbiological diagnosis, these estimations may be misleading. The availability of reliable serology for the diagnosis of COVID-19 may overcome this drawback. This study was carried out in order to reveal the actual incidence of SARS-CoV-2 infection in PLWH in Southern Spain.Methods: This is a prospective cohort study including HIV infected patients from the Unit of Infectious Diseases of a university hospital in Seville, Southern Spain. Patients were enrolled in the study if 1) they had attended the outpatient clinic from September 1st to December 31st, 2019 (baseline), and 2) had a subsequent evaluation from March 1st to June 30th, 2020 (intra-pandemic). Serum antibodies against SARS-CoV-2 were determined in baseline and intra-pandemic samples.Results: 326 patients were included in the study. Of them, 4 (1.25% [95% CI: 0.3%-3.1%]) developed COVID-19. One patient developed bilateral pneumonia and died. The remaining three showed mild respiratory symptoms suggesting COVID-19. No asymptomatic SARS-CoV-2 infection was observed in this study. No patient with COVID-19 was tobacco smoker. The incidence of COVID-19 among non-smokers was 2.5% (95% CI [0.6%-6%], p=0.057 versus smokers).Conclusions: The incidence of COVID-19 among PLWH in our area was low and similar to that observed in the general population. The frequency of asymptomatic cases might be lower than in patients without HIV infection. Tobacco smoking could be associated to a lower incidence of COVID-19.

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Section: Discussionsupporting

confidence: 89%

Incidence of COVID-19 among people living with HIV in Southern Spain

Fernández‐Fuertes¹,

Rodriguez-Pineda²,

Fuentes-López³

et al. 2020

Preprint

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“…Despite these optimistic findings, the lack of higher risk for severe COVID‐19 in PLWH has been recently questioned by several studies reporting worse outcomes in HIV‐positive subjects compared to the general population, and particularly in frailer subgroups as elderly, 4,13,14 patients with underlying comorbidities, 14,15 more severely immunosuppressed patients, 13,14 and black people 16 . Indeed, older age and comorbidities, already identified as risk factors for severe disease in the general population, have been clearly related to a greater risk of both acquiring and having a severe clinical course of COVID‐19 also in PLWH 4,13–15 . Notably, several studies have reported a significant correlation between age and disease severity, 14 with a greater risk of morbidity and mortality for COVID‐19 in the older age strata of the HIV‐positive population compared to the general population 4,13 .…”

Section: Discussionmentioning

confidence: 99%

“…16 Indeed, older age and comorbidities, already identified as risk factors for severe disease in the general population, have been clearly related to a greater risk of both acquiring and having a severe clinical course of COVID-19 also in PLWH. 4,[13][14][15] Notably, several studies have reported a significant correlation between age and disease severity, 14 with a greater risk of morbidity and mortality for COVID-19 in the older age strata of the HIV-positive population compared to the general population. 4,13 The premature aging and the premature burden of age-related diseases due to the chronic immune activation, which characterizes HIV-positive subjects, might probably explain these results.…”

mentioning

confidence: 99%

COVID‐19 in people living with HIV: Clinical implications of dynamics of the immune response to SARS‐CoV‐2

Mondi

Cimini

Colavita

et al. 2020

Journal of Medical Virology

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Background Little evidence on COVID‐19 in people living with HIV (PLWH) is currently available. Material and Methods We reported clinical and viro‐immunological data of all HIV‐positive patients admitted to our centre with COVID‐19 from March 1 to May 12 , 2020. Results Overall, five patients were included: all were virologically‐suppressed on antiretroviral therapy and CD4+ count was >350 cell/mm 3 in all but two patients. Although all patients had evidence of pneumonia on admission, only one developed respiratory failure. SARS‐CoV‐2‐RNA was never detected from nasopharyngeal swabs in two patients, whereas, in the others, viral clearance occurred within a maximum of 43 days. IgG production was elicited in all patients and neutralizing antibodies in all but one patient. Specific‐T‐cell response developed in all patients but was stronger in those with more severe presentation. Similarly, the highest level of pro‐inflammatory cytokines was found in the only patient experiencing respiratory failure. Despite a mild presentation, patients with more pronounced immunosuppression showed high degrees of both cytokines production and immune‐activation. Conclusions Our study did not find an increased risk and severity of COVID‐19 in PLWH. Adaptative cellular immune response to SARS‐CoV‐2 appeared to correlate to disease severity. The mild clinical picture showed in advanced HIV patients, despite a significant T‐cell activation and inflammatory profile, suggests a potential role of HIV‐driven immunological dysregulation in avoiding immune‐pathogenetic processes. However, other possible explanations, as a protective role of certain antiretroviral drugs, should be considered. Further larger studies are needed to better clarify the impact of HIV infection on COVID‐19. This article is protected by copyright. All rights reserved.

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“…However, Suwanwongse et al observed the clinical features and outcomes of nine HIV/SARS-CoV-2 coinfected patients and found that low CD4 + T cell counts in the HIV-positive patients may adversely affect the COVID-19 outcomes [14]. Maggiolo compared 55 cases of SARS-CoV-2 infection with 69 asymptomatic people living with HIV (PLHIV) negative for SARS-CoV-2 RT-PCR and/or serology, and suggested that HIVpositive individuals are not protected from SARS-CoV-2 infection or have a lower risk of severe disease and those with low CD4 + T cell counts might have worse outcomes [15]. Studies also suggested that HIV-positive individuals should not be considered to be protected from SARS-CoV-2 infection or to have lower risk of severe disease [16,17].…”

Section: Resultsmentioning

confidence: 99%

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

Zhang¹,

Yu²,

Ding³

et al. 2020

BMC Infect Dis

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Background COVID-19 is novel infectious disease with an evolving understanding of its epidemiology and clinical manifestations. Severe cases developed life-threatening complications, such as respiratory failure, shock, and multiple organs dysfunction. Immunocompromised patients often present atypical presentations of viral infected diseases. Case presentation We report newly diagnosed HIV infections in two patients with COVID-19 in China. In our two cases, both patients with elevated IL-6 received Tocilizumab treatment, but did not present obvious therapeutic effect. Conclusions These cases highlight possible co-detection of known immunocompromised diseases such as HIV. The two cases we reported stressed the risk of misdiagnosis, especially during the pandemic of an infectious disease and the importance of extended testing even if in immune-compromised condition the immune state may be ignored.

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SARS‐CoV‐2 infection in persons living with HIV: A single center prospective cohort

Cited by 37 publications

References 16 publications

Incidence of COVID-19 among people living with HIV in Southern Spain

Incidence of COVID-19 among people living with HIV in Southern Spain

COVID‐19 in people living with HIV: Clinical implications of dynamics of the immune response to SARS‐CoV‐2

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

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