Description of COVID-19 in HIV-infected individuals: a single-centre, prospective cohort

1. Clinical characteristics of HIV-infected individuals appear to be similar to that of the general population and as such should have a similar treatment approach applied.

Evidence Rating: 2 (Good)

Despite there being a significant population of infected individuals, the relationship between HIV and COVID-19 was poorly characterized. Specifically, it was unclear as to whether HIV-infected individuals may have been at increased risk of SARS-CoV-2 infection or severe disease, owing to lower CD4 cell counts or unsuppressed HIV viral load, or alternatively have reduced risk and variable clinical presentation from immunosuppression and regular antiviral therapy.  In this observational prospective study, researchers followed up on the data of 2873 HIV-infected individuals, 51 of which whom were diagnosed with COVID-19 (35 laboratory confirmed, 16 suspected). Thirty eight (75%) patients had mild or moderate disease, six (12%) individuals were critically ill, and two (4%) died. When comparing HIV positive patients with and without SARS-CoV-2 infection, no differences were found in the age distribution, nadir CD4 cell counts, and the proportion of individuals on ART, though patients with COVID-19 had a higher median body-mass index and prevalence of chronic comorbidities.  Interestingly, a significantly higher proportion of COVID-19 infected patients had received tenofovir before COVID-19 diagnosis compared to SARS-CoV-2 negative patients (73% versus 38%). Lymphocyte counts were correlated with CD4 counts (ρ=0·54; p=0·0036), and individuals with lower lymphocytes counts were at higher risk of severe disease ((ρ=0·049). Individuals with SARS-CoV-2 positivity at follow-up had longer mean time since diagnosis of HIV infection than those who had negative test results (26·9 years [SD 8·2] vs 16·3 years [9·6]; p=0·023). Clinical, analytical, and radiological presentation of COVID-19 in HIV-infected individuals was similar to that described in the general population. Although the population of infected patients was relatively small, this study represents one of the first to characterize the clinical characteristics of HIV positive patients diagnosed with COVID-19. Overall, no major distinctions in clinical presentation from the general population were identified, and as such no major alterations to approach to treatment were suggested. As factors such as BMI and tenofovir usage had been identified as predictive factors  for COVID-19 however, future studies should further investigate any possible interactions between these variables and COVID-19.

Click to read the study in The Lancet

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