The Presence of Either Typical or Atypical Radiological Changes Predicts Poor COVID-19 Outcomes in HIV-Positive Patients from a Multinational Observational Study: Data from Euroguidelines in Central and Eastern Europe Network Group

Abstract

HIV-positive patients may present lungs with multiple infections, which may hinder differential diagnoses and the choice of treatment in the course of COVID-19, especially in countries with limited access to high-standard healthcare. Here, we aim to investigate the association between radiological changes and poor COVID-19 outcomes among HIV-positive patients from Central and Eastern Europe. Between November 2020 and May 2021, the Euroguidelines in Central and Eastern Europe Network Group started collecting observational data on HIV and COVID-19 co-infections. In total, 16 countries from Central and Eastern European submitted data (eCRF) on 557 HIV-positive patients. The current analyses included patients who had a radiological examination performed. Logistic regression models were used to identify the factors associated with death, ICU admission, and partial recovery (poor COVID-19 outcomes). Factors that were significant in the univariate models (p < 0.1) were included in the multivariate model. Radiological data were available for 224 (40.2%) patients, 108 (48.2%) had computed tomography, and 116 (51.8%) had a chest X-ray. Of these, 211 (94.2%) were diagnosed using RT-PCR tests, 212 (94.6%) were symptomatic, 123 (55.6%) were hospitalized, 37 (16.6%) required oxygen therapy, and 28 (13.1%) either died, were admitted to ICU, or only partially recovered. From the radiologist’s description, 138 (61.6%) patients had typical radiological changes, 18 (8.0%) atypical changes, and 68 (30.4%) no changes. In the univariate models, CD4 count (OR = 0.86 [95% CI: 0.76–0.98]), having a comorbidity (2.33 [1.43–3.80]), HCV and/or HBV co-infection (3.17 [1.32–7.60]), being currently employed (0.31 [0.13–0.70]), being on antiretroviral therapy (0.22 [0.08–0.63]), and having typical (3.90 [1.12–13.65]) or atypical (10.8 [2.23–52.5]) radiological changes were all significantly associated with poor COVID-19 outcomes. In the multivariate model, being on antiretroviral therapy (OR = 0.20 [95% CI:0.05–0.80]) decreased the odds of poor COVID-19 outcomes, while having a comorbidity (2.12 [1.20–3.72]) or either typical (4.23 [1.05–17.0]) or atypical (6.39 [1.03–39.7]) radiological changes (vs. no changes) increased the odds of poor COVID-19 outcomes. Among HIV patients diagnosed with symptomatic SARS-CoV-2 infection, the presence of either typical or atypical radiological COVID-19 changes independently predicted poorer outcomes.

The Clinical Effectiveness and Safety of Vaccinations against COVID-19 in HIV-Positive Patients: Data from Observational Study in Poland

“…People living with HIV are a non-homogeneous group of immunocompromised persons, which includes both low CD4 count and ongoing immune activation impacting the response differently to and course of other viral infections [ 3 , 4 ]. Detectable viral load and concomitant chronic comorbidities independently increase the risk of severe outcomes of COVID-19 in this group of patients [ 5 , 6 , 7 , 8 ].…”

CT imaging of HIV-associated pulmonary disorders in COVID-19 pandemic

“…According to retrospective study of Kowalska et al, the presence of typical or atypical radiological changes is associated with poor prognosis for HIV infected patients with COVID-19 coinfection. 76 Findings such as consolidation, nodules, cysts, and spontaneous pneumothorax occurring in the course of COVID-19 should raise the suspicion of secondary infection, and HIV-positive patients should undergo a broad differential diagnosis 106. 76 Primary coinfections in COVID-19 are rare.…”

“… 76 Findings such as consolidation, nodules, cysts, and spontaneous pneumothorax occurring in the course of COVID-19 should raise the suspicion of secondary infection, and HIV-positive patients should undergo a broad differential diagnosis 106. 76 Primary coinfections in COVID-19 are rare. 77 This is also true for HIV-positive patients; to date, there have been only case reports published on concomitant COVID-19, HIV, and other disease, typically represented by fungal pneumonia or tuberculosis 108,109.…”

Immunological and Clinical Responses to Vaccinations among Adults Living with HIV

“…Considering the onset of the COVID-19 pandemic in early 2020 and the major global threat, the development of a vaccine against SARS-CoV-2 became a new priority in vaccinology [57]. An increased risk of a severe clinical course of the disease was rapidly observed in the elderly and those with comorbidities, including patients living with HIV [58,59]. The first clinical trials on the effectiveness of the newly developed vaccines began to emerge, including in high-risk subpopulations [60].…”