Study fails to establish independent risk factors for SARS-COV-2 infection in HIV patients

As the COVID-19 pandemic continues to spread worldwide, a new study published in the International Journal of Infectious Diseases in September 2020 reports that people with HIV infection are not at greater risk of COVID-19 compared to the general population.

Low Proportion of HIV Patients Infected with COVID-19

The study, carried out at the Bichat University Hospital in Paris, covers over 5,300 people living with HIV (PLWHIV). Of these, only 0.5% (30 patients in all) were positive for the virus. Among this number, 70% were hospitalized for the disease, while 30% were outpatients.

Men and women made up 60% and 33% of this group, with ~7% being transgender. The median patient age was ~54 years, and over three-quarters were born out of France. About a third had cardiovascular disease, diabetes, and obesity, while less than a fifth had chronic kidney disease. This reflects the comorbidities most commonly seen in severe or critical COVID-19.

Two-thirds of the patients in this group were overweight, while only five had a Charlson comorbidity index of 3 or more. At the conclusion of the study, two patients had died (~7%), while four were still in hospital. The worst outcomes were observed in patients with a higher CCI score.

Overall, 3 needed mechanical ventilation. This is similar to that seen in other studies, but the mortality in this study was lower compared to 21% in other studies.

Favorable HIV Profile in Most Patients

The HIV infection was dormant in 90% of the patients, and of the remaining 3 patients, 2 had only a low HIV viral load. About three-quarters had a CD4 cell count above 500 cells/mm3. This suggests that other risk factors than HIV-induced immunosuppression were at work for COVID-19.

While 80% of the patients were positive for the viral RNA by polymerase chain reaction (PCR) testing, two were negative but had typical findings of COVID-19 on chest CT scanning. In 3 patients, the diagnosis was made based on anosmia or ageusia without a nasal swab at a median of 7 days from the onset of symptoms.

Treatment regimens had to be altered in only one patient due to the critical medical condition. About 16% of patients required additional antiviral treatment for COVID-19, mostly because of severe disease, requiring an oxygen flow of over 3 liters per minute.  The same number needed dexamethasone and tocilizumab.

Implications

The study concludes, “Risk factors were the same as those described in other SARS-COV2 series, suggesting that HIV infection is probably not an independent risk factor for covid-19 infection.”

Most of these patients were on effective anti-retroviral treatment and were virologically suppressed, with a high CD4 count. Further studies are required to establish the risk factors, the clinical outcomes, and treatment options in PLWHIV who contract COVID-19.

Journal reference:
Dr. Liji Thomas

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.

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