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Background:
Brief Report

Characteristics and Outcomes of COVID-19-Related Hospitalization among PLWH

by
Roberta Gagliardini
†,
Alessandra Vergori
*,†,
Patrizia Lorenzini
,
Stefania Cicalini
,
Carmela Pinnetti
,
Valentina Mazzotta
,
Annalisa Mondi
,
Ilaria Mastrorosa
,
Marta Camici
,
Simone Lanini
,
Marisa Fusto
,
Jessica Paulicelli
,
Maria Maddalena Plazzi
,
Luisa Marchioni
,
Chiara Agrati
,
Anna Rosa Garbuglia
,
Pierluca Piselli
,
Emanuele Nicastri
,
Fabrizio Taglietti
,
Fabrizio Palmieri
,
Gianpiero D’Offizi
,
Enrico Girardi
,
Francesco Vaia
and
Andrea Antinori
add Show full author list remove Hide full author list
National Institute for Infectious Diseases Lazzaro Spallanzani, IRCCS, Via Portuense, 292, 00149 Roma, Italy
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
J. Clin. Med. 2022, 11(6), 1546; https://doi.org/10.3390/jcm11061546
Submission received: 12 February 2022 / Revised: 4 March 2022 / Accepted: 8 March 2022 / Published: 11 March 2022
(This article belongs to the Topic Fighting against COVID-19: Latest Advances, Challenges and Methodologies)
Review Reports Versions Notes

Abstract

:
Background: There is conflicting evidence for how HIV influences COVID-19 infection. The aim of this study was to compare characteristics at presentation and the clinical outcomes of people living with HIV (PLWH) versus HIV-negative patients (non-PLWH) hospitalized with COVID-19. Methods: Primary endpoint: time until invasive ventilation/death. Secondary endpoints: time until ventilation/death, time until symptoms resolution. Results: A total of 1647 hospitalized patients were included (43 (2.6%) PLWH, 1604 non-PLWH). PLWH were younger (55 vs. 61 years) and less likely to be with PaO2/FiO2 < 300 mmHg compared with non-PLWH. Among PLWH, nadir of CD4 was 185 (75–322) cells/μL; CD4 at COVID-19 diagnosis was 272 cells/μL (127–468) and 77% of these were virologically suppressed. The cumulative probability of invasive mechanical ventilation/death at day 15 was 4.7% (95%CI 1.2–17.3) in PLWH versus 18.9% (16.9–21.1) in non-PLWH (p = 0.023). The cumulative probability of non-invasive/invasive ventilation/death at day 15 was 20.9% (11.5–36.4) in PLWH versus 37.6% (35.1–40.2) in non-PLWH (p = 0.044). The adjusted hazard ratio (aHR) of invasive mechanical ventilation/death of PLWH was 0.49 (95% CI 0.12–1.96, p = 0.310) versus non-PLWH; similarly, aHR of non-invasive/invasive ventilation/death of PLWH was 1.03 (95% CI 0.53–2.00, p = 0.926). Conclusion: A less-severe presentation of COVID-19 at hospitalization was observed in PLWH compared to non-PLWH; no difference in clinical outcomes could be detected.
Keywords:
HIV; COVID-19; SARS-CoV-2

1. Introduction

COVID-19 disease, related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged as the greatest health issue of 2020.
To date, no conclusive evidence about the relationship between COVID-19 and HIV infection is available. In fact, many small cohort studies failed to demonstrate a higher risk rate of COVID-19 or more aggressive course of disease in people living with HIV (PLWH) compared to those without HIV (non-PLWH) [1,2,3,4,5,6,7,8,9].
However, larger and more recent studies reported a higher risk of poor outcomes of COVID-19 in PLWH, in particular a higher mortality rate [10,11,12,13,14], higher rate of hospitalization due to COVID-19 [15] or higher rate of in-hospital intubation [11].
The WHO Global Clinical Platform for COVID-19 affirmed that HIV appeared to be a significant independent risk factor for severe or critical illness at hospital admission and in-hospital mortality. In this analysis, including more than 15,000 PLWH, data were predominantly from South Africa, and this may limit the generalizability of the results [16].
Two small studies from the UK and France suggested a substantial morbidity or mortality from COVID-19 among Black PLWH [16,17]. Moreover, PLWH might have high prevalence of risk factors for severe SARS-CoV-2 infection, including hypertension, diabetes, cardiovascular disease, lung disease, smoking, and the male sex [17]. Uncontrolled HIV infection or advanced immunodeficiency, in the context of additional co-morbidities, might have a higher risk of COVID-19-related death [18].
Moreover, limited information about the difference in levels of inflammatory and immune markers among people hospitalized with COVID-19 by HIV serostatus is available [10,15].
Thus, continued data collections that explores the coinfection between PLWH and COVID-19 are warranted to clarify their mutual relationship and the role of traditional risk factors for COVID-19 outcomes in PLWH.
The aim of this study was to compare characteristics at presentation and clinical outcomes of PLWH versus HIV-negative patients hospitalized with COVID-19.

2. Materials and Methods

We conducted a retrospective cohort study in the INMI COVID-19 Database of L. Spallanzani Institute in Rome (Italy), which contains data from patients who had a diagnosis of COVID-19 from January 2020 and were hospitalized in L. Spallanzani Institute in Rome. INMI COVID-19 Database was approved by the local INMI, Rome Ethical Committee, and patients provided written informed consent. The study was performed in accordance with the Declaration of Helsinki. INMI COVID-19 Database retrieves epidemiological, demographic, clinical and laboratory data of patients, as well therapy prescribed for COVID-19 patients.
Patients were included in this study if the following inclusion criteria were satisfied: ≥18 years of age, a diagnosis of SARS-CoV-2 infection, defined as positive RT-PCR from nasal/oropharyngeal (NP/OP) swab; admitted at INMI L. Spallanzani Institute in Rome (Italy).
Pneumonia was evaluated by CT scan. All patients had PaO2/FiO2 ratio measured at admission by arterial blood gas analysis.
The start of follow-up (baseline) for each patient was the time of admission to the hospital. All patients were followed up from baseline until death, discharge, last available visit or the administrative censored date of 1 June 2021, whichever occurred first.
Primary endpoint of this study was the evaluation of time from baseline to invasive ventilation or death (whichever occurred first).
Secondary endpoints were: (i) the evaluation of time from start of therapy to non-invasive or invasive ventilation or death (whichever occurred first), (ii) time until symptoms resolution, defined as resolution of fever (first day without fever) or weaning from oxygen (first day without oxygen supplementation). Non-invasive ventilation includes CPAP and NIV.
Baseline demographic characteristics, symptoms, immune and inflammatory marker levels were compared by HIV serostatus.
Use of therapy with immuno-modulants (e.g., anti-IL6, anti-JAK), corticosteroids, heparin, hydroxychloroquine or lopinavir/ritonavir was based on local medical consensus, guidelines and the clinicians’ own opinions.
For the statistical analysis, chi-square or Wilcoxon rank sum (Mann–Whitney) tests were used to compare categorical or continuous variables in descriptive analyses, respectively.
Kaplan–Meier survival method was used to estimate the cumulative proportion of patients experiencing study endpoints, with a corresponding 95% confidence interval (CI); differences between PLWH versus HIV-negative patients (non-PLWH) were evaluated by the log-rank test.
In order to control for measured confounders, a Cox regression model was used, adjusted for the following variables: age, gender, comorbidities, ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) and pneumonia at admission to the hospital.
A sensitivity analysis including only patients with COVID-19 pneumonia was performed.
All statistical analyses were performed with STATA.

3. Results

3.1. Population Characteristics

A total of 1647 patients hospitalized with a diagnosis of COVID-19 were evaluated in this analysis, of whom 43 were PLWH and 1604 were non-PLWH. Of 1647 patients, 33.4% were female, the median age was 61 years (IQR 50–74), 82.8% were of Italian nationality, and 72.4% had at least one comorbidity. At hospitalization, 90% had a diagnosis of pneumonia, median baseline PaO2/FiO2 321 (IQR 230–386) mmHg, days from onset of symptoms to hospitalization 7 (IQR 4–10). Demographic characteristics, signs, symptoms and biomarkers are shown in Table 1.
PLWH were significantly younger and less likely to be with PaO2/FiO2 below 300 mmHg at admission, with less alterations in D-dimer, ferritin and slight alternations in lymphocytes compared with non-PLWH (Table 1).
Symptoms at presentation were similar in the two groups, apart from headache, which was more frequent in PLWH (Table 1).
Viro-immunological characteristics of the PLWH group were the following: median CD4+ cells count at COVID-19 diagnosis: 272 cells/μL (IQR127–468); median CD4+ cells count at lowest point: 185 cells/μL (IQR75–322); 32% with a previous diagnosis of AIDS, all had antiretroviral therapy; and 77% had HIV-1 RNA < 50 copies/mL at COVID-19 diagnosis. Characteristics of PLWH who were not virologically suppressed are shown in detail in Table 2, but a sub-analysis of the above-specified endpoints was not performed in this population due to the small dimension of this subgroup.

3.2. Invasive Ventilation or Death

Overall, 306 patients over 1647 (18.6%) underwent to invasive ventilation or death, two in PLWH group.
By Kaplan–Meyer analysis, the estimated probability of invasive ventilation or death was 4.7% (95% CI 1.2–17.3) in PLWH and 18.9% (95% CI 16.1–21.1) in non-PLWH 15 days after hospitalization (log-rank test = 0.023).
Following the adjustment for age, gender, comorbidities, PaO2/FiO2 and pneumonia at admission, the adjusted hazard ratio (aHR) of mechanical ventilation/death of PLWH was 0.49 (95% CI 0.12–1.96, p = 0.310) versus non-PLWH.

3.3. Non-Invasive or Invasive Ventilation or Death

The cumulative probability of non-invasive or invasive ventilation/death at day 15 was 20.9% (11.5–36.4) in PLWH versus 37.6% (35.1–40.2) in non-PLWH (log-rank test = 0.044).
Following the adjustment for the aforementioned variables, the aHR of non-invasive or invasive ventilation/death of PLWH was 1.03 (95% CI 0.53–2.00, p = 0.926).

3.4. Symptoms Resolution

The cumulative probability of symptoms resolution at day 15 was 65.3% (48.4–81.7) in PLWH versus 50.5% (47.6–53.4) in non-PLWH (log-rank test = 0.041).
In the adjusted model, the probability of symptoms resolution at day 15 PLWH was similar in the two groups (aHR 0.92; 0.63–1.36; p = 0.691).

3.5. Sensitivity Analysis

A total of 1494 patients hospitalized with diagnoses of COVID-19 pneumonia were evaluated in this sensitivity analysis. By Kaplan–Meyer analysis, the estimated probabilities of invasive ventilation or death was 6.5% (95% CI 1.7–23.4) in PLWH and 20.5% (95% CI 18.4–23.4) in non-PLWH after 15 days of hospitalization (log-rank test = 0.073).
Following adjustment for age, gender, comorbidities, PaO2/FiO2, aHR of mechanical ventilation/death of PLWH was 0.46 (95% CI 0.11–1.85, p = 0.272) versus non-PLWH.
The cumulative probability of non-invasive or invasive ventilation/death at day 15 was 29.0% (16.3–48.4) in PLWH versus 40.69% (38.3–43.7) in non-PLWH (log-rank test = 0.276). Following adjustment for the same variables, aHR of non-invasive or invasive ventilation/death of PLWH was 1.02 (95% CI 0.53–1.98, p = 0.954).
The cumulative probability of symptoms resolution at day 15 was 58.2% (39.8–77.7) in PLWH versus 49.9% (39.8–77.7) in non-PLWH (log-rank test = 0.162).

4. Discussion

The impact of HIV coinfection on the clinical course of patients with COVID-19 has yet to be fully clarified.
Our findings suggest that HIV status did not significantly impact clinical outcomes in patients with SARS-CoV-2 coinfection and are in line with other large studies conducted in the US, which evaluated clinical evolution and mortality among PLWH and COVID-19 [19,20]. This study was conducted on a cohort of 7576 veterans (Veterans Aging Cohort Study, VACS) and states that people with HIV are more likely to be assessed for COVID-19, but there is no difference in the risk of hospitalization, ICU admission, intubation or death between HIV-positive and HIV-negative patients [19].
A previous study investigating clinical outcomes in a small case series of patients admitted to our institute, did not find an increased risk and severity of COVID-19 in PLWH despite a significant T-cell activation and inflammatory profile, suggesting a potential role of HIV-driven immunological dysregulation in avoiding immune-pathogenetic processes [21].
Moreover, lymphopenia in COVID-19 infection seems to be a relevant factor for the progression of severity of illness [22].
CD4 lymphopenia was reported with variable severity of COVID-19 infection. It was hypothesized that a low CD4 count might protect PLWH from the development of the cytokine storm, which is part of the COVID-19 clinical syndrome, and potentially reduce some of the severe manifestations of COVID-19 infection [23] resulting in a protective feature in preventing severe clinical manifestations of COVID-19 infection [6,7,24,25]. In our cohort, PLWH had quite low CD4+ levels at COVID-19 diagnosis (272 CD4+ cells/μL [IQR 127–468]).
A study derived from a large US database included more than 50,000 patients with COVID-19, of whom about 49,000 were HIV-negative and 400 were HIV-positive, mostly of African American ethnicity, obese, hypertensive, with diabetes, renal failure and other concomitant diseases. This demonstrated that the severity of COVID-19 in PLWH might be dependent on the presence of comorbidities [9]. Subsequent to this study, Boulle and colleagues showed an approximately 2.7-fold increased risk of death from COVID-19 in the HIV-positive population compared to the HIV-negative population, after adjustment for confounding factors such as age, the presence of other concomitant infectious and non-infectious diseases [26]. Both studies emphasize that the severity of COVID-19 in HIV-positive patients was not due to the presence of HIV itself, but to the ageing and comorbidities of these individuals [9,26].
Moreover, a systematic review by Cooper T. et al. on 70 PLWH from 8 studies did show that well-controlled HIV patients were not associated with poorer outcomes of COVID-19 infection than the general population, which was similar to our observation [27].
According to the WHO Global Clinical Platform for COVID-19, HIV infection is an independent risk factor of worse COVID-19 outcomes, but these data were predominantly from South Africa, mainly without information on antiretroviral therapy. Moreover, not all potentially relevant risk factors, such as body mass index, were evaluated [16].
In our cohort, HIV-positive patients were significantly younger than the HIV-negative comparator, mostly virologically suppressed before COVID-19 and with a median CD4 count of 272 cells/μL; hence, these findings may not be applicable to a population with poorly controlled HIV or AIDS. The two groups did not differ in terms of COVID-19 symptoms (only headache was more frequent in PLWH) and comorbidities, with the exception of hypertension and cardiovascular diseases found in a significantly higher proportion of HIV-negative patients.
At time of admission to hospital, hypoxemia, the need for oxygen supplementation, and pneumonia were significantly more frequent in those without HIV; these differences could be explained by the older age of those without HIV and/or increased prevalence of cardiovascular diseases.
Among the seven PLWH not virologically suppressed, only two PLWH had an AIDS diagnosis at admission; the other patients had more than one comorbidity. All of them were discharged alive with no COVID-related complications, except one patient who required invasive mechanical ventilation and died for reasons not related to COVID-19.
The main limitation of this study is the retrospective analysis, performed in a single medical center; therefore, results may not be generalizable to other centers and may also be limited by a small sample size. Larger prospective studies from multiple centers will be needed to verify findings from this study and to examine the impact of poorly controlled HIV on the clinical course of SARS-CoV-2. Additionally, given the lack of immunological data on all study subjects, we are unable to report on the immunological response of PLWH to SARS-CoV-2 infection as compared with patients with COVID-19 but not with HIV infection. Taken together, our findings are reassuring in that HIV-positive patients on antiretroviral therapy may not experience significantly worse outcomes in SARS-CoV-2, even though these data should be considered with caution. This urges us not to rush to conclusions about a reversal of previous data on large cohorts telling us that HIV still remains a risk factor for COVID-19.

Author Contributions

Conceptualization, R.G., A.V. and A.A.; methodology, P.L.; formal analysis, P.L.; investigation, S.C., A.M., V.M., I.M., M.C., S.L., M.F., J.P., M.M.P., E.N., C.P., F.T., L.M., C.A., A.R.G., F.P., G.D. and F.V.; resources, P.P. and E.G.; data curation, R.G. and P.L.; writing—original draft preparation, R.G. and A.V.; writing—review and editing, R.G. and A.V.; supervision, A.A. All authors have read and agreed to the published version of the manuscript.

Funding

The study was funded by Ricerca Finalizzata COVID-2020-12371675 and by Ricerca Corrente linea 2.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki. INMI COVID-19 Database was approved by the local INMI, Rome Ethical Committee and patients provided written informed consent. The study was performed in accordance with the declaration of Helsinki. The INMI COVID-19 Database retrieves epidemiological, demographic, clinical and laboratory data of patients, as well therapy prescribed for COVID-19 patients.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

Data supporting reported results can be provided upon request to the authors.

Acknowledgments

Collaborators Members of the National Institute for Infectious Diseases (INMI) ReCOVeRI study group: Maria Alessandra Abbonizio, Amina Abdeddaim, Elisabetta Agostini, Chiara Agrati, Fabrizio Albarello, Gioia Amadei, Alessandra Amendola, Andrea Antinori, Maria Assunta Antonica, Mario Antonini, Tommaso Ascoli Bartoli, Francesco Baldini, Raffaella Barbaro, Barbara Bartolini, Rita Bellagamba, Martina Benigni, Nazario Bevilacqua, Gianluigi Biava, Michele Bibas, Licia Bordi, Veronica Bordoni, Evangelo Boumis, Marta Branca, Rosanna Buonomo, Donatella Busso, Marta Camici, Paolo Campioni, Flaminia Canichella, Maria Rosaria Capobianchi, Alessandro Capone, Cinzia Caporale, Emanuela Caraffa, Ilaria Caravella, Fabrizio Carletti, Concetta Castilletti, Adriana Cataldo, Stefano Cerilli, Carlotta Cerva, Roberta Chiappini, Pierangelo Chinello, Maria Assunta Cianfarani, Carmine Ciaralli, Claudia Cimaglia, Nicola Cinicola, Veronica Ciotti, Stefania Cicalini, Francesca Colavita, Angela Corpolongo, Massimo Cristofaro, Salvatore Curiale, Alessandra D’Abramo, Cristina Dantimi, Alessia De Angelis, Giada De Angelis, Maria Grazia De Palo, Federico De Zottis, Virginia Di Bari, Rachele Di Lorenzo, Federica Di Stefano, Gianpiero D’Offizi, Davide Donno, Francesca Evangelista, Francesca Faraglia, Anna Farina, Federica Ferraro, Lorena Fiorentini, Andrea Frustaci, Matteo Fusetti, Vincenzo Galati, Roberta Gagliardini, Paola Gallì, Gabriele Garotto, Ilaria Gaviano, Saba Gebremeskel Tekle, Maria Letizia Giancola, Filippo Giansante, Emanuela Giombini, Guido Granata, Maria Cristina Greci, Elisabetta Grilli, Susanna Grisetti, Gina Gualano, Fabio Iacomi, Marta Iaconi, Giuseppina Iannicelli, Carlo Inversi, Giuseppe Ippolito, Eleonora Lalle, Maria Elena Lamanna, Simone Lanini, Daniele Lapa, Luciana Lepore, Raffaella Libertone, Raffaella Lionetti, Giuseppina Liuzzi, Laura Loiacono, Andrea Lucia, Franco Lufrani, Manuela Macchione, Gaetano Maffongelli, Alessandra Marani, Luisa Marchioni, Andrea Mariano, Maria Cristina Marini, Micaela Maritti, Annelisa Mastrobattista, Ilaria Mastrorosa, Giulia Matusali, Valentina Mazzotta, Paola Mencarini, Silvia Meschi, Francesco Messina, Sibiana Micarelli, Giulia Mogavero, Annalisa Mondi, Marzia Montalbano, Chiara Montaldo, Silvia Mosti, Silvia Murachelli, Maria Musso, Michela Nardi, Assunta Navarra, Emanuele Nicastri, Martina Nocioni, Pasquale Noto, Roberto Noto, Alessandra Oliva, Ilaria Onnis, Sandrine Ottou, Claudia Palazzolo, Emanuele Pallini, Fabrizio Palmieri, Giulio Palombi, Carlo Pareo, Virgilio Passeri, Federico Pelliccioni, Giovanna Penna, Antonella Petrecchia, Ada Petrone, Nicola Petrosillo, Elisa Pianura, Carmela Pinnetti, Maria Pisciotta, Pierluca Piselli, Silvia Pittalis, Agostina Pontarelli, Costanza Proietti, Vincenzo Puro, Paolo Migliorisi Ramazzini, Alessia Rianda, Gabriele Rinonapoli, Silvia Rosati, Dorotea Rubino, Martina Rueca, Alberto Ruggeri, Alessandra Sacchi, Alessandro Sampaolesi, Francesco Sanasi, Carmen Santagata, Alessandra Scarabello, Silvana Scarcia, Vincenzo Schininà, Paola Scognamiglio, Laura Scorzolini, Giulia Stazi, Giacomo Strano, Fabrizio Taglietti, Chiara Taibi, Giorgia Taloni, Tetaj Nardi, Roberto Tonnarini, Simone Topino, Martina Tozzi, Francesco Vaia, Francesco Vairo, Maria Beatrice Valli, Alessandra Vergori, Laura Vincenzi, Ubaldo Visco-Comandini, Serena Vita, Pietro Vittozzi, Mauro Zaccarelli, Antonella Zanetti and Sara Zito.

Conflicts of Interest

R.G. received institutional grant from Gilead Sciences, personal fees for consultancy from Janssen-Cilag, M.S.D., Gilead, Viiv and Theratechnologies; A.V. received institutional grant from Gilead Sciences, personal fees for consultancy and travel grant from Janssen-Cilag, speaker’s fee from M.S.D.; S.C. received personal fees for consultancy from Janssen-Cilag, M.S.D., Gilead and Viiv; C.P. received travel grants and honoraria from Gilead and Janssen-Cilag; A.M. received honoraria from Gilead Sciences and Viiv Healthcare; E.N. received training fee and medical board from Gilead Science, S.O.B.I., Eli Lilly and Roche; EG received grants from Gilead e Mylan, speakers fee from Gilead; A.A. received personal fees for consultancy from Janssen-Cilag, M.S.D., Gilead, GlaxoSmithKline, Theratechnologies, Roche and Viiv. The other authors have nothing to declare.

References

  1. Blanco, J.L. Correspondence COVID-19 in patients with HIV: Clinical case series. Lancet HIV 2020, 7, e314–e316. [Google Scholar] [CrossRef]
  2. Gervasoni, C.; Meraviglia, P.; Riva, A.; Giacomelli, A.; Oreni, L.; Minisci, D.; Atzori, C.; Ridolfo, A.; Cattaneo, D. Clinical features and outcomes of HIV patients with coronavirus disease 2019. Clin. Infect. Dis. 2020, 71, 2276–2278. [Google Scholar] [CrossRef] [PubMed]
  3. Karmen-Tuohy, S.; Carlucci, P.M.; Zervou, F.N.; Zacharioudakis, I.M.; Rebick, G.; Klein, E.; Reich, J.; Jones, S.; Rahimian, J. Outcomes Among HIV-Positive Patients Hospitalized With COVID-19. J. Acquir. Immune Defic. Syndr. 2020, 85, 6–10. [Google Scholar] [CrossRef] [PubMed]
  4. Sigel, K.; Swartz, T.; Golden, E.; Paranjpe, I.; Somani, S.; Richter, F.; De Freitas, J.K.; Miotto, R.; Zhao, S.; Polak, P.; et al. Coronavirus 2019 and People Living with Human Immunodeficiency Virus: Outcomes for Hospitalized Patients in New York City. Clin. Infect. Dis. 2020, 10029, 2933–2938. [Google Scholar] [CrossRef] [PubMed]
  5. Shalev, N.; Scherer, M.; LaSota, E.D.; Antoniou, P.; Yin, M.T.; Zucker, J.; Sobieszczyk, M.E. Clinical Characteristics and Outcomes in People Living With Human Immunodeficiency Virus Hospitalized for Coronavirus Disease 2019. Clin. Infect. Dis. 2020, 24, 2294–2297. [Google Scholar] [CrossRef] [PubMed]
  6. Suwanwongse, K.; Shabarek, N. Clinical features and outcome of HIV/SARS-CoV-2 coinfected patients in The Bronx, New York city. J. Med. Virol. 2020, 92, 2387–2389. [Google Scholar] [CrossRef]
  7. Vizcarra, P.; Pérez-Elías, M.J.; Quereda, C.; Moreno, A.; Vivancos, M.J.; Dronda, F.; Casado, J.L.; Moreno, S.; Fortún, J.; Navas, E.; et al. Description of COVID-19 in HIV-infected individuals: A single-centre, prospective cohort. Lancet HIV 2020, 7, e554–e564. [Google Scholar] [CrossRef]
  8. Cabello, A.; Zamarro, B.; Nistal, S.; Victor, V.; Hernández, J.; Prieto-pérez, L.; Carrillo, I.; Álvarez, B.; Fernández-Roblas, R.; Hernández-Segurado, M.; et al. COVID-19 in people living with HIV: A multicenter case-series study. Int. J. Infect. Dis. 2020, 102, 310–315. [Google Scholar] [CrossRef]
  9. Hadi, Y.B.; Naqvi, S.F.Z.; Kupec, J.T.; Sarwari, A.R. Characteristics and outcomes of COVID-19 in patients with HIV: A multicentre research network study. AIDS 2020, 34, F3–F8. [Google Scholar] [CrossRef]
  10. Tesoriero, J.M.; Swain, C.E.; Pierce, J.L.; Zamboni, L.; Wu, M.; Holtgrave, D.R.; Gonzalez, C.J.; Udo, T.; Morne, J.E.; Hart-Malloy, R.; et al. COVID-19 Outcomes Among Persons Living With or Without Diagnosed HIV Infection in New York State. JAMA Netw. Open 2021, 4, e2037069. [Google Scholar] [CrossRef]
  11. Patel, V.V.; Felsen, U.R.; Fisher, M.; Fazzari, M.J.; Ginsberg, M.S.; Beil, R.; Akiyama, M.J.; Anastos, K.; Hanna, D.B. Clinical Outcomes and Inflammatory Markers by HIV Serostatus and Viral Suppression in a Large Cohort of Patients Hospitalized With COVID-19. JAIDS J. Acquir. Immune Defic. Syndr. 2021, 86, 224–230. [Google Scholar] [CrossRef] [PubMed]
  12. Childs, K.; Post, F.A.; Norcross, C.; Ottaway, Z.; Hamlyn, E.; Quinn, K.; Juniper, T.; Taylor, C. Hospitalized Patients with COVID-19 and Human Immunodeficiency Virus: A Case Series. Clin. Infect. Dis. 2020, 71, 2021–2022. [Google Scholar] [CrossRef] [PubMed]
  13. Etienne, N.; Karmochkine, M.; Slama, L.; Pavie, J.; Batisse, D.; Usubillaga, R.; Letembet, V.-A.; Brazille, P.; Canouï, E.; Slama, D.; et al. HIV infection and COVID-19: Risk factors for severe disease. AIDS 2020, 34, 1771–1774. [Google Scholar] [CrossRef] [PubMed]
  14. Sze, S.; Pan, D.; Nevill, C.R.; Gray, L.J.; Martin, C.A.; Nazareth, J.; Minhas, J.S.; Divall, P.; Khunti, K.; Abrams, K.R.; et al. Ethnicity and clinical outcomes in COVID-19: A systematic review and meta-analysis. EClinicalMedicine 2020, 29, 100630. [Google Scholar] [CrossRef]
  15. Geretti, A.M.; Stockdale, A.J.; Kelly, S.H.; Cevik, M.; Collins, S.; Waters, L.; Villa, G.; Docherty, A.; Harrison, E.M.; Turtle, L.; et al. Outcomes of COVID-19 related hospitalisation among people with HIV in the ISARIC 2 WHO Clinical Characterisation Protocol UK Protocol: Prospective observational study. Clin. Infect. Dis. 2020, 73, e2095–e2106. [Google Scholar] [CrossRef]
  16. Bertagnolio, S.; Thwin, S.S.; Silva, R.; Diaz, J. Clinical Features and Prognostic Factors of COVID-19 in People Living with HIV Hospitalized with Suspected or Confirmed SARS-CoV-2 Infection; WHO Global Clinical Pltaform for COVID-19; World Health Organization: Geneva, Switzerland, 2021. [Google Scholar]
  17. Lesko, C.R.; Bengtson, A.M. HIV and COVID-19: Intersecting Epidemics with Many Unknowns. Am. J. Epidemiol. 2021, 190, 10–16. [Google Scholar] [CrossRef]
  18. BHIVA; DAIG; EACS; GESIDA; Polish Scientific AIDS Society and Portuguese Association for the Clinical Study of AIDS (APECS). Statement on Risk of COVID-19 for People Living with HIV (PLWH) and SARS-CoV-2 Vaccine Advice for Adults Living with HIV; British HIV Association: Macclesfield, UK, 2021; Volume 6, pp. 1–8. [Google Scholar]
  19. Park, L.S.; Rentsch, C.T.; Sigel, K.; Rodriguez-Barradas, M.; Brown, S.T.; Goetz, M.B.; Williams, E.C.; Althoff, K.; Bräu, N.; Aoun-Barakat, L.; et al. COVID-19 in the Largest US HIV Cohort. In Proceedings of the 23rd International AIDS Conference, Virtual Conference, 6–10 July 2020. [Google Scholar]
  20. Kaplan-Lewis, E.; Banga, J.; Khan, M.; Casey, E.; Mazumdar, M.; Bratu, S.; Abdallah, M.; Pitts, R.; Leider, J.; Hennessey, K.; et al. HIV Diagnosis and the Clinical Course of COVID-19 among Patients Seeking Care within the New York City Public Hospital System during the Initial Pandemic Peak. AIDS Patient Care STDS 2021, 35, 457–466. [Google Scholar] [CrossRef]
  21. Mondi, A.; Cimini, E.; Colavita, F.; Cicalini, S.; Pinnetti, C.; Matusali, G.; Casetti, R.; Maeurer, M.; Vergori, A.; Mazzotta, V.; et al. COVID-19 in people living with HIV: Clinical implications of dynamics of the immune response to SARS-CoV-2. J. Med. Virol. 2020, 93, 1796–1804. [Google Scholar] [CrossRef]
  22. Zhao, Q.; Meng, M.; Kumar, R.; Wu, Y.; Huang, J.; Deng, Y.; Weng, Z.; Yang, L. Lymphopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A systemic review and meta-analysis. Int. J. Infect. Dis. 2020, 96, 131–135. [Google Scholar] [CrossRef]
  23. Guo, W.; Ming, F.; Dong, Y.; Zhang, Q.; Zhang, X.; Mo, P.; Feng, Y.; Liang, K. A Survey for COVID-19 Among HIV/AIDS Patients in Two Districts of Wuhan, China. SSRN Electron. J. 2020. [Google Scholar] [CrossRef]
  24. Mascolo, S.; Romanelli, A.; Carleo, M.A.; Esposito, V. Could HIV infection alter the clinical course of SARS-CoV-2 infection? When less is better. J. Med. Virol. 2020, 92, 1777–1778. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  25. Härter, G.; Spinner, C.D.; Roider, J.; Bickel, M.; Krznaric, I.; Grunwald, S.; Schabaz, F.; Gillor, D.; Postel, N.; Mueller, M.C.; et al. COVID-19 in people living with human immunodeficiency virus: A case series of 33 patients. Infection 2020, 48, 681–686. [Google Scholar] [CrossRef] [PubMed]
  26. Boulle, A.; Davies, M.-A.; Hussey, H.; Ismail, M.; Morden, E.; Vundle, Z.; Zweigenthal, V.; Mahomed, H.; Paleker, M.; Pienaar, D. Risk factors for COVID-19 death in a population cohort study from the Western Cape Province, South Africa. Clin. Infect. Dis. 2020, 73, e2005–e2015. [Google Scholar] [CrossRef]
  27. Cooper, T.J.; Woodward, B.L.; Alom, S.; Harky, A. Coronavirus disease 2019 (COVID-19) outcomes in HIV/AIDS patients: A systematic review. HIV Med. 2020, 21, 567–577. [Google Scholar] [CrossRef] [PubMed]
Table
Table 1. Demographics, comorbidities, baseline characteristics, presenting symptoms and biomarkers of the overall population and of the 2 groups (non-PLWH and PLWH).
Table 1. Demographics, comorbidities, baseline characteristics, presenting symptoms and biomarkers of the overall population and of the 2 groups (non-PLWH and PLWH).
CharacteristicsTotal PopulationNon-PLWHPLWHp-Value
N = 1647N = 1604N = 43
Gender
Male, n(%)1097 (66.6)1065 (66.4)32 (74.4)0.271
Age, years, median (IQR)61 (50–74)61 (50–74)55 (47–62)0.003
Not Italian, n (%)283 (17.2)268 (16.7)15 (34.9)0.002
BMI, median (IQR)25.9 (24.0–29.4)26.0 (24.0–29.4)24.7 (22.0–28.4)0.062
At least 1 comorbidity, n (%)1192 (72.4)1165 (72.6)27 (62.8)0.154
Obesity, n (%)226 (20.9)223 (21.1)3 (10.3)0.255
Diabetes, n (%)273 (16.6)270 (16.8)3 (7.0)0.086
Heart diseases, n (%)422 (25.6)419 (26.1)3 (7.0)0.005
Hypertension, n (%)644 (39.1)638 (39.8)6 (14.0)0.001
Chronic lung diseases, n (%)241 (14.6)237 (14.8)4 (9.3)0.316
CNS diseases, n (%)178 (10.8)174 (10.9)4 (9.3)0.723
Therapies
HCQ, n (%)403 (24.5)398 (24.8)5 (11.6)0.047
PI/b, n (%)455 (27.6)438 (27.3)17 (39.5)0.077
Remdesivir, n (%)454 (27.6)438 (27.3)16 (37.2)0.152
Immune therapy, n (%)158 (9.6)156 (9.7)2 (4.7)0.265
LMWH, n (%)1316 (79.9)1284 (80.1)32 (74.4)0.363
Steroids, n (%)956 (58.0)937 (58.4)19 (44.2)0.062
PaO2/FiO2 ratio <300 at admission, n (%)627 (38.1)619 (38.6)8 (18.6)0.011
PaO2/FiO2 ratio at admission, median (IQR)321 (230–386)319 (229–386)376 (314–438)0.007
Worst PaO2/FiO2 ratio during FU, median (IQR)234 (138–350)232 (138–348)338 (232–414)0.001
Pneumonia, n (%)1494 (90.7)1463 (91.2)31 (72.1)<0.001
Oxygen supplementation, n (%)1244 (75.6)1217 (75.9)27 (62.8)0.048
Venturi Mask, n (%)1077 (65.4)1053 (65.7)24 (55.8)0.181
NIV, n (%)475 (28.8)467 (29.1)8 (16.6)0.133
OTI, n (%)234 (14.2)232 (14.5)2 (4.7)0.069
Time from symptoms to admission, days, median (IQR)7 (4–10)7 (4–10)8 (5–10)0.148
Time until viral clearance from symptoms, median (IQR)19 (13–27)19 (13–27)21 (14–32)0.252
Headache, n (%)136 (8.3)127 (7.9)9 (20.9)0.001
Flu-like symptoms, n (%)31 (2.9%)28 (2.7%)3 (9.7%)0.022
Cough, n (%)534 (49.7%)523 (50.1%)11 (35.5%)0.109
White blood cells, ×109/L, median (IQR)6.2 (4.8–8.5)6.2 (4.8–8.6)6.4 (5.0–8.0)0.881
Neutrophils, ×109/L, median (IQR)4.3 (2.8–6.5)4.3 (2.8–6.5)4.0 (2.7–5.7)0.542
Lymphocytes, ×109/L, median (IQR)1130 (780–1630)1120 (770–1630)1290 (990–1780)0.063
Hemoglobin, g/dL, median (IQR)13.5 (12.1–14.7)13.5 (12.1–14.7)13.5 (12.1–14.6)0.976
Platelets, ×106/L, median (IQR)219 (172–282)219 (172–282)206 (153–288)0.604
Potassium, mEq/L, median (IQR)3.6 (3.4–3.9)3.6 (3.4–3.9)3.5 (3.3–3.9)0.532
C-reactive protein, mg/L, median (IQR)2.9 (1.0–8.2)2.9 (1.0–8.2)3.1 (1.3–6.6)0.910
D-dimer, mg/L, median (IQR)659 (400–1266)666 (403–1274)479 (324–746)0.014
Ferritin, mg/L, median (IQR)380 (176–833)389 (177–838)243 (159–313)0.033
Notes: PLWH, people living with HIV; IQR, interquartile range; BMI, body mass index; HCV-Ab, hepatitis C virus antibodies; HBsAg, Hepatitis B surface antigen; PaO2/FiO2, ratio of arterial oxygen partial pressure to fractional inspired oxygen; NIV, non-invasive ventilation; OTI, oro-tracheal intubation.
Table
Table 2. Characteristics of PLWH who were not virologically suppressed.
Table 2. Characteristics of PLWH who were not virologically suppressed.
EthnicityGenderAgeHIV RNA,
Copies/mL		CD4 Count
at Admission, Cells/mm3		AIDS Defining Disease
at Admission		COVID-19 PneumoniaComorbiditiesPaO2/FiO2
at Admission, mmHg		Worst PaO2/FiO2 during FU, mmHgOxygen TherapyInvasiv VentilationDeath
Patient 1BlackF28222,7134Criptococcal meningitisYesNo357263yesIOTYes
Patient 2WhiteM53289536Kaposi sarcoma,
HIV Encefalopathy		NoCOPD495495NoNONo
Patient 3WhiteF564070,60353NoNoCOPD,
HCV chronic hepatitis		462462NoNoNo
Patient 4Afro-AmericanM48125792NoNoHypertension, OSAS386386NoNoNo
Patient 5WhiteF71573,680271NoYesNo338338NoNono
Patient 6WhiteM63671,810272NoYesHypertension, dyslipidemia,
CKD		248195YesNoNo
Patient 7Afro-AmericanM48792184NoNoSquamous cell carcinoma
of rectum		NANANoNono
Abbreviations: COPD, chronic obstructive pulmonary disease; OSAS, obstructive sleep apnea syndrome; CKD, chronic kidney disease; FU, follow up; NA, not available.
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Gagliardini, R.; Vergori, A.; Lorenzini, P.; Cicalini, S.; Pinnetti, C.; Mazzotta, V.; Mondi, A.; Mastrorosa, I.; Camici, M.; Lanini, S.; et al. Characteristics and Outcomes of COVID-19-Related Hospitalization among PLWH. J. Clin. Med. 2022, 11, 1546. https://doi.org/10.3390/jcm11061546

AMA Style

Gagliardini R, Vergori A, Lorenzini P, Cicalini S, Pinnetti C, Mazzotta V, Mondi A, Mastrorosa I, Camici M, Lanini S, et al. Characteristics and Outcomes of COVID-19-Related Hospitalization among PLWH. Journal of Clinical Medicine. 2022; 11(6):1546. https://doi.org/10.3390/jcm11061546

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Gagliardini, Roberta, Alessandra Vergori, Patrizia Lorenzini, Stefania Cicalini, Carmela Pinnetti, Valentina Mazzotta, Annalisa Mondi, Ilaria Mastrorosa, Marta Camici, Simone Lanini, and et al. 2022. "Characteristics and Outcomes of COVID-19-Related Hospitalization among PLWH" Journal of Clinical Medicine 11, no. 6: 1546. https://doi.org/10.3390/jcm11061546

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