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People with HIV not at higher risk of death or severe illness from COVID-19

Two studies of COVID-19 cases published in recent days lead investigators to the cautious conclusion that people living with HIV are not at higher risk of death or severe illness, but one study shows a higher frequency of bacterial pneumonia leading to death in people living with HIV hospitalised with COVID-19, reports Aidsmap.

Researchers at New York University Grossman School of Medicine identified 21 people living with HIV hospitalised with COVID-19 at NYU Langone Health between 2 March and 23 April 2020. HIV status was ascertained from electronic medical records so this group represents all people with a recorded HIV-positive status admitted to the hospital. The researchers matched these patients with 42 HIV-negative coronavirus patients by admission date, age, body mass, gender, smoking and underlying health conditions associated with a higher risk of death from COVID-19.

The investigators conclude that “HIV did not significantly impact clinical outcomes” but “we did detect trends suggesting that outcomes may be worse in HIV-positive patients.” They express concern about bacterial pneumonia as a predictor of mortality in HIV-positive patients and urge further research on this question.

The New York cases series has been made available as a pre-print and is undergoing peer review, so the study conclusions are preliminary.

Twelve HIV clinics in Germany reported on the outcomes of 33 people living with HIV diagnosed with COVID-19 between 11 March and 17 April 2020. The researchers at Medicover Ulm MVZ, Technical University of Munich, and University Hospital Klinikum rechts der Isar don’t explain the testing protocol employed by the clinics that led to the identification of these patients, so it’s unclear if they represent all people with HIV diagnosed with SARS-CoV-2 receiving HIV care at those clinics, or just patients who were tested for SARS-CoV-2 on the initiative of physicians after coming into contact with the clinic.

The German investigators conclude that this preliminary case series does not indicate a higher risk of severe illness or death from COVID-19 in people living with HIV.

Both research groups conclude that HIV infection does not raise the risk of severe COVID-19, but as doctors at London’s Chelsea and Westminster Hospital note in a letter in The Lancet, “appropriately powered and designed studies are needed to draw conclusions on the effect of COVID-19 in people with chronic diseases, including HIV infection.”

In particular, these studies do not shed light on whether COVID-19 causes severe immunosuppression that worsens outcomes or predisposes people to develop bacterial pneumonia.

The higher frequency of bacterial pneumonia in people living with HIV in the New York case series underlines the need for vigilance regarding bacterial pneumonia in people living with HIV with COVID-19 symptoms.

Abstract 1
Background: SARS-CoV-2 infection continues to cause significant morbidity and mortality worldwide. Preliminary data on SARS-CoV-2 infection suggests that some immunocompromised hosts experience worse outcomes. We performed a retrospective matched cohort study to characterize outcomes in HIV-positive patients with SARS-CoV-2 infection.
Methods: Leveraging data collected from electronic medical records for all patients hospitalized at NYU Langone Health with COVID-19 between March 2, 2020 and April 23, 2020, we matched 21 HIV-positive patients to 42 non-HIV patients using a greedy nearest neighbor algorithm. Admission characteristics, laboratory results, and hospital outcomes were recorded and compared between the two groups.

Results: While there was a trend toward increased rates of ICU admission, mechanical ventilation, and mortality in HIV-positive patients, these differences were not statistically significant. Rates for these outcomes in our cohort are similar to those previously published for all patients hospitalized with COVID-19. HIV-positive patients had significantly higher admission and peak CRP values. Other inflammatory markers did not differ significantly between groups, though HIV-positive patients tended to have higher peak values during their clinical course. Three HIV-positive patients had superimposed bacterial pneumonia with positive sputum cultures, and all three patients expired during hospitalization. There was no difference in frequency of thrombotic events or myocardial infarction between these groups.
Conclusion: This study provides evidence that HIV coinfection does not significantly impact presentation, hospital course, or outcomes of patients infected with SARS-CoV-2, when compared to matched non-HIV patients. A larger study is required to determine if the trends we observed apply to all HIV-positive patients.

Authors
Savannah Karmen-Tuohy, Philip M Carlucci, Ioannis M Zacharioudakis, Fainareti N Zervou, Gabriel Rebick, Elizabeth Klein, Jenna Reich, Simon Jones, Joseph Rahimian

Abstract
Introduction: Data on people living with human immunodeficiency virus (PLWH) in the current SARS-CoV-2 pandemic are still scarce. This case series of 33 PLWH patients with COVID-19 reveals symptoms and outcome in this special population.
Methods: Retrospective analysis of anonymized data including age, gender, HIV-associated parameters, symptoms, and outcome.
Results: Three out of 32 patients with documented outcomes died (9%). 91% of the patients recovered and 76% have been classified as mild cases. All patients were on antiretroviral treatment, of them 22 on tenofovir-containing regimen and 4 on the protease inhibitor darunavir.

Conclusions: This preliminary case series does not support excess morbidity and mortality among symptomatic COVID-19 PLWH and with viral suppression on ART. SARS-CoV-2 infections may occur during boosted darunavir-based and/or on tenofovir-containing ART.

Authors
Georg Härter, Christoph D Spinner, Julia Roider, Markus Bickel, Ivanka Krznaric, Stephan Grunwald, Farhad Schabaz, Daniel Gillor, Nils Postel, Matthias C Mueller, Markus Müller, Katja Römer, Knud Schewe, Christian Hoffmann

[link url="http://www.aidsmap.com/news/may-2020/no-increased-risk-severe-covid-19-people-living-hiv-vigilance-over-bacterial"]Full Aidsmap report[/link]

[link url="http://www.aidsmap.com/news/may-2020/no-increased-risk-severe-covid-19-people-living-hiv-vigilance-over-bacterial"]Medxriv abstract[/link]

[link url="https://link.springer.com/article/10.1007/s15010-020-01438-z"]Inection abstract[/link]

[link url="https://www.thelancet.com/pdfs/journals/lanhiv/PIIS2352-3018(20)30139-9.pdf"]The Lancet correspondence[/link]

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