Nothing Special About COVID-19 Manifestations in People With HIV

By Megan Brooks

April 22, 2020

NEW YORK (Reuters Health) - The clinical characteristics of COVID-19 in patients with HIV appear to be similar to those without HIV, according to a small case series from Spain.

"What we can say is that HIV infection accounts for 1% of hospital admissions for COVID-19 in Barcelona, that the clinical picture is similar to that of the general population, and that none of the five patients died despite the fact that two were admitted to an intensive-care unit (ICU)," Dr. Jose M. Miro, from Hospital Clinic Barcelona, University of Barcelona, told Reuters Health by email.

In a report in The Lancet HIV, Dr. Miro and colleagues describe their experience with COVID-19 in the setting of HIV, including clinical characteristics, antiviral and antiretroviral treatment, and outcomes.

Among the 543 patients with COVID-19 who were admitted to their hospital on March 9 (two weeks into the outbreak in Spain), five (0.92%) were HIV-positive. All were younger than age 50 years. Three were male and two were transgender. Four identified as men who have sex with men (MSM) and one as bisexual.

Two patients who were MSM were sex workers and one reported participating in a "chemsex" party six days before being admitted to the hospital with COVID-19.

"During this pandemic, implementing health education programs is very important to explain that such activities as these could cause clusters of SARS-CoV-2 transmission," the clinicians advise.

Four of the patients were virologically suppressed on antiretroviral therapy (ART); CD4 counts were above 400 cells/uL in all patients apart from patient 5, who was ART naive and presented late with advanced HIV.

The clinicians say they adapted ART in all patients to a regimen based on protease inhibitors. Three patients were given lopinavir-boosted ritonavir and two were given darunavir-boosted cobicistat.

"In the past month, a clinical trial found that lopinavir-boosted ritonavir was ineffective as a monotherapy against severe pneumonia associated with COVID-19 in China. Therefore, investigation of the efficacy of this treatment in patients with COVID-19 in combined therapy in earlier stages of the disease is needed," they note in their article. In addition, Janssen recently reported that darunavir was not effective against SARS-CoV-2 due to low affinity to coronavirus protease, they point out.

All five HIV-infected patients had a COVID-19 clinical picture resembling the general population. As of April 15, none of the five patients has died, although two were admitted to the ICU, where one remains, the clinicians say.

COVID-19 treatment included hydroxychloroquine in four patients and it was combined with azithromycin in three patients. None of the patients were treated with remdesivir, which "is currently only available through clinical trials or for compassionate use. This drug has no pharmacokinetic interactions with any medication including ART drugs," the authors write.

"This pandemic is a challenge affecting everyone. By generating information such as we present here, the management and prognosis of patients co-infected with HIV and SARS-CoV-2 might be improved," they conclude.

SOURCE: The Lancet HIV, online April 15, 2020.