by Jeffrey T. Kirchner, DO, AAHIVS, AAHIVM Chief Medical Officer

October 27, 2020

Featured Literature:
Dandachi, D et al. Characteristics, Comorbidities, and Outcomes in a Multicenter Registry of Patients with HIV and Coronavirus Disease-19. Clin Infect Dis. 2020 September 9th: ciaa1339. doi:10.1093/cid/ciaa1339

Since the onset of the COVID-19 pandemic, there have been multiple reports of clinical outcomes of persons with HIV (PWH) who have been infected with Coronavirus. The data continues to be quite variable depending on location and specific patient populations. This multicenter study from the U.S. is a consecutive, non-randomized sampling of PWH with lab-confirmed COVID-19, diagnosed between April 1st and July 1st, 2020. Laboratory-confirmed COVID-19 was defined as either a positive RT-PCR test from a respiratory sample or serum SARS-CoV-2 specific antibody (IgM/IgG). The primary endpoint was “severe outcome,” defined as admission to the ICU, need for mechanical ventilation, or death. The secondary outcome was the need for hospitalization. The study included 286 patients with a mean age of 51 years. The majority (94%) were on ART with 90% having an undetectable viral load, however, 81% had comorbidities. Within 30 days of a positive SARS-CoV-2 test, 57% were hospitalized and 29% were admitted to the ICU. The overall mortality rate was 9.4% (27/286) and 16.5% (27/164) of those hospitalized and 52% (24/47) who required ICU level of care. Chronic pulmonary disease, hypertension, and older age (>60 years) were associated with a severe outcome. Having a CD4 count of < 200 was associated with the primary and secondary endpoints. There was no association with any specific class of ART or lack of viral suppression with the predefined endpoints.

Author’s Commentary:

The clinical outcomes from this study are currently the worse in terms of morbidity and mortality reported for PWH and COVID 19. This study is the first to characterize outcomes in a geographically diverse patient population. Similar to what has been reported in other studies, comorbidities were associated with poor outcomes. However, this study is one of the first that found that a low CD4 count (< 200 cells/mm3) was associated with poor outcomes including overall survival. The data suggest that PWH with a history of advanced HIV disease or recent ART initiation should have closer observation and monitoring.  Sadly, this study also confirmed the unequal racial and gender distribution of PWH and COVID-19.

The author has no conflicts of interest to disclose.

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