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HIV patients: Low CD4 cell count may increase COVID-19 mortality threefold

People with HIV who had a low CD4 cell count or underlying health conditions were more likely to have poor outcomes after admission to hospital with COVID 19, US doctors report. Aidsmap reports that they found that even when HIV was suppressed on antiretroviral treatment, people with low CD4 counts below 200 were almost three times more likely to die of COVID-19 than people with CD4 counts above 500. Several studies have shown an increased risk of death from COVID-19 in people living with HIV, especially in people with comorbidities.

The COVID-19 in People with HIV Registry was established by Dr Dima Dandachi of the University of Missouri to collect data on COVID-19 in people with HIV who had laboratory-confirmed SARS-CoV2 infection. Providers at 36 institutions (all but three in the US) contributed data on eligible patients, including 17 institutions which searched medical records systematically and included all identified cases. This analysis covers all patients entered in the registry between 1 April and 1 July 2020.

The registry collected data on 286 people with HIV, 7% from outside the US. The mean age was 51 years, 26% were female, 48% African-American and 28% Hispanic – 94% were taking HIV treatment and 89% were virally suppressed. More than half (61%) were taking an integrase inhibitor and the mean CD4 cell count was 531.

Comorbidities were strongly associated with hospital admission. A low current CD4 cell count was also independently associated with hospital admission and also a severe outcome. People with HIV with CD4 cell counts below 200 were around three times more likely to be admitted to hospital with COVID-19 (OR 3.67, 95% CI 1.64-17.1, p<0.01) or to suffer a severe outcome (OR 2.8, 95% CI 1.02-7.67, p=0.05) than people with CD4 cell counts above 500. People with CD4 counts in the range 200 – 500 were also at slightly raised risk of admission to hospital with COVID-19 (OR 1.12, 95% CI 1.1-12.2, p=0.03).

Abstract
Background: People with HIV (PWH) may have numerous risk factors for acquiring Coronavirus disease-19 (COVID-19) and developing severe outcomes, but current data are conflicting.
Methods: Healthcare providers enrolled consecutively by non-random sampling PWH with lab-confirmed COVID-19, diagnosed at their facilities between April 1st and July 1st, 2020. De-identified data were entered into an electronic Research Electronic Data Capture (REDCap). The primary endpoint was severe outcome, defined as a composite endpoint of intensive care unit (ICU) admission, mechanical ventilation, or death. The secondary outcome was the need for hospitalization.
Results: 286 patients were included; the mean age was 51.4 years (SD, 14.4), 25.9% were female, and 75.4% were African-American or Hispanic. Most patients (94.3%) were on antiretroviral therapy (ART), 88.7% had HIV virologic suppression, and 80.8% had comorbidities. Within 30 days of positive SARS-CoV-2 testing, 164 (57.3%) patients were hospitalized, and 47 (16.5%) required ICU admission. Mortality rates were 9.4% (27/286) overall, 16.5% (27/164) among those hospitalized, and 51.5% (24/47) among those admitted to an ICU. The primary composite endpoint occurred in 17.5% (50/286) of all patients and 30.5% (50/164) of hospitalized patients. Older age, chronic lung disease, and hypertension were associated with severe outcomes. A lower CD4 count (<200 cells/mm³) was associated with the primary and secondary endpoints. There was no association between the antiretroviral regimen or lack of viral suppression and predefined outcomes.
Conclusion: Severe clinical outcomes occurred commonly in PWH and COVID-19. The risk for poor outcomes was higher in those with comorbidities and lower CD4 cell counts, despite HIV viral suppression.

Authors
Dima Dandachi, Grant Geiger, Mary W Montgomery, Savannah Karmen-Tuohy, Mojgan Golzy, Annukka AR Antar, Josep M Llibre, Maraya Camazine, Alberto Díaz-De Santiago, Philip M Carlucci, Ioannis M Zacharioudakis, Joseph Rahimian, MD, Celestine N Wanjalla, Jihad Slim, Folasade Arinze, Ann Marie Porreca Kratz, Joyce L Jones, Shital M Patel, Ellen Kitchell, Adero Francis, Manoj Ray, David E Koren, John W Baddley, Brannon Hill, Paul E Sax, Jeremy Chow

 

[link url="https://www.aidsmap.com/news/sep-2020/low-cd4-count-increased-risk-covid-19-death-us-people-hiv"]Full Aidsmap report[/link]

 

[link url="https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa1339/5903368"]Clinical Infectious Diseases abstract[/link]

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