Outcomes Among HIV-Positive Patients Hospitalized With COVID-19

Savannah Karmen-Tuohy, BS; Philip M. Carlucci, BS; Fainareti N. Zervou, MD; Ioannis M. Zacharioudakis, MD; Gabriel Rebick, MD; Elizabeth Klein, BS; Jenna Reich, BS; Simon Jones, PhD; Joseph Rahimian, MD

Disclosures

J Acquir Immune Defic Syndr. 2020;85(1):6-10. 

In This Article

Results

HIV-positive patients (N = 21) and matched non-HIV patients (N = 42) did not differ significantly in age, sex, race, tobacco use, or medical history (see Table 1, Supplemental Digital Content,http://links.lww.com/QAI/B494). In the HIV-positive cohort, 19 patients and 17 patients had CD4 count and viral load results, respectively, recorded before or on the first day of admission. Patients in the HIV-positive cohort had a median last CD4 count of 298/μL, and only 6 of the 19 patients had a last measured CD4 count less than 200/μL. Fifteen of 17 patients had a viral load less than 50 copies/mL, and all patients in the HIV-positive cohort were on highly active antiretroviral therapy before admission. HIV-positive and non-HIV groups did not differ statistically on initial white blood cell count, hemoglobin, absolute neutrophil count, ferritin, D-dimer, troponin, creatine phosphokinase, procalcitonin, or creatinine. HIV-positive patients had a higher absolute lymphocyte count (mean ± SD, HIV+: 1.09 ± 0.53 vs. non-HIV: 0.88 ± 0.39, P value: 0.043) and higher C-reactive protein (CRP) (HIV+: 154.48 ± 94.44 vs. non-HIV: 96.1 ± 90.0, P value: 0.020) on initial laboratory test results than non-HIV patients (Table 1).

A greater percentage of HIV-positive patients had an abnormal finding of consolidation, infiltrate, or opacity on initial chest imaging than non-HIV patients [HIV+: 19 (90.5%) vs non-HIV: 27 (64.3%)], although no statistical difference was seen between the groups when analyzing the finding of bilateral consolidation, opacity, or infiltrate ever present on chest imaging during this hospitalization (Table 2). When analyzing COVID-related treatments received, there was a significant difference in the use of corticosteroids between HIV-positive and non-HIV patients. Four HIV-positive patients received corticosteroids, whereas no patient from the non-HIV group received this treatment. None of the HIV-positive patients received corticosteroids at the time of their last T-cell measurement, and therefore, we do not expect this to have had any impact on the measured CD4 count for these patients.

Although there was a trend toward HIV-positive patients experiencing longer hospital stays and higher rates of intensive care unit (ICU) admission, mechanical ventilation, and discharge to hospice or mortality, we did not find a statistically significant difference between the HIV-positive and non-HIV cohort on these measures. Supplemental oxygen characteristics, such as average or maximum O2 flow rate and FiO2, were not statistically different between these groups, although HIV-positive patients trended toward higher O2 flow rates when compared with non-HIV patients. Although not statistically significant, HIV-positive patients had a nominally higher peak lactate dehydrogenase, ferritin, procalcitonin, and D-dimer. HIV-positive patients had statistically significant higher peak CRP values than non-HIV patients (HIV+: 185.13 ± 107.35 vs. non-HIV: 128.06 ± 99.29, P value: 0.024). Because HIV-positive patients had significantly higher admission and peak CRP values, we performed a logistic regression to see whether CRP predicted mortality among HIV-positive patients and found no association with mortality using admission CRP [odds ratio: 1.007, 95% confidence interval (CI): 0.998 to 1.015, N = 18]. However, we did observe a weakly significant association between the highest peak CRP values and mortality among HIV-positive patients (odds ratio: 1.026, 95% CI: 1.002 to 1.051, N = 20). A similar weak association was found among non-HIV patients (odds ratio: 1.018, 95% CI: 1.006 to 1.029, N = 38). Last measured CD4 count did not associate with mortality in HIV-positive patients (odds ratio: 0.996, 95% CI: 0.992 to 1.11).

Both groups were evaluated for complications of stroke, myocardial infarction, pulmonary embolism, and deep vein thrombosis. No patients included in this study experienced a stroke. Two patients, 1 each from the HIV-positive and non-HIV groups, experienced both pulmonary embolism and ST-segment elevation myocardial infarction documented on imaging, electrocardiogram, or clinical record.

The presence of a superimposed bacterial pneumonia was also evaluated. Twelve total patients (6 HIV-positive and 6 non-HIV) had sputum cultures performed because of clinical suspicion of bacterial superinfection. Four patients had positive sputum cultures, 3 of whom were HIV-positive. Of these patients with positive sputum results, 2 patients had polymicrobial infections, and cultures grew Pseudomonas aeruginosa (2 patients), Stenotrophomonas maltophilia (2 patients), Klebsiella pneumoniae (1 patient), Staphylococcus aureus (1 patient), and Escherichia coli (1 patient). All 4 patients with positive cultures were subsequently treated with antibiotics for bacterial pneumonia, and all 4 died in the hospital. Clinical suspicion of a superimposed pneumonia occurred at least 6 days or more before death in each case.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....