Virologic and Immunologic Outcomes for HIV Patients With Coronavirus Disease 2019

Rong Hu, MPH; Han Yan, MPH; Manqing Liu, MSc; Li Tang, MPH; Wenhua Kong, MSc; Zerong Zhu, MSc; Pan Liu, MSc; Wenjuan Bai, MPH; Xuejiao Hu, MPH; Jie Ding, BD; Xia Wang, MPH; Nianhua Xie, MPH

Disclosures

J Acquir Immune Defic Syndr. 2021;86(2):213-218. 

In This Article

Results

The detailed participant recruitment and survey could be seen in Figure 1, Supplemental Digital Content, http://links.lww.com/QAI/B558. The loss to follow-up rate was 15.2%.

Demographics

The median age of PLHIV coinfected with SARS-CoV-2 was 52.0 (IQR, 36.0–57.0) years, 33 (94.3%) were men. The most commonly reported comorbidities were hypertension (25.0%) and diabetes (10.7%). Most participants reported alcohol consumption and smoking in the never category (71.4% and 67.9% respectively; Table 1).

Among the 35 subjects, 20 were identified as asymptomatic/mild/moderate COVID-19 (nonsevere group) and 15 were severe/critical COVID-19 (severe group). Age, gender, history of comorbidities, alcohol consumption, and smoking were all evenly distributed between severe and nonsevere group (all P > 0.05).

Baseline HIV Status

The identified coinfected cases have been living with HIV for 70.0 (IQR, 42.0–91.0) months at onset of COVID-19. Fifteen (42.9%) of them have progressed into AIDS stage. Thirty-four (97.1%) were on ART against HIV infection before onset of COVID-19 and the median duration from ART initiation to onset of COVID-19 was 61.0 months (IQR, 34.0–80.0). One patient (2.9%) initiated ART at the onset of COVID-19. Four PLHIV (14.3%) reported not on ART for at least 3 days since December, 2019, among which 1/4 reported the reason of city lockdown in COVID-19 epidemic, 2/4 of under COVID-19 treatment, and 1/4 of toxic side effects of ART. ART regimens mainly included the combined use of nucleoside reverse transcriptase inhibitors and non-nucleoside reverse transcriptase inhibitors (32/35, 91.4%). Only 3/35 included the use of protease inhibitors or integrase inhibitors (Table 1).

There were no statistically significant differences of duration of HIV infection (P = 0.199) and ART against HIV infection (P = 0.111) between severe and nonsevere groups (Table 1).

Clinical Findings Related to COVID-19

Twenty-one of 35 subjects were confirmed cases, 3/35 were asymptomatic cases, and 11/35 were clinically diagnosed cases. A total of 24 COVID-19 cases, namely the confirmed cases and asymptomatic cases, tested positive for SARS-CoV-2 viral RNA in respiratory samples at their diagnosis. At follow-up, 1/28 tested positive for SARS-CoV-2 IgM antibody, and 22/28 tested positive for SARS-CoV-2 IgG antibody (Table 1).

Most of the enrolled COVID-19 cases were identified in January, 2020 (71.4%) and February, 2020 (22.9%). The most common symptoms were fever (25/35, 71.4%), dry cough (13/35, 37.1%), and shortness of breath (8/35, 22.9%). The severe group was significantly more likely to have shortness of breath than the nonsevere group (40.0% vs. 10.0%, P = 0.051). The median time from symptoms onset to medical visit were 6.0 (IQR, 1.0–8.0) days. Twenty-nine (82.9%) reported to have history of hospital stay, among which 4 were admitted to and discharged from Fangcang shelter hospital, 2 were transferred from Fangcang shelter hospital to other medical facilities for severe progression of COVID-19. The median time of hospital stay was 16 (IQR, 11.5–32.5) days. At the point of tele-survey, 33 patients recovered and were discharged, whereas the other 2 died due to critical COVID-19 at 52 and 68 years old. Nine of the 33 survived patients reported to have family members with COVID-19 and 4/33 reported to have colleagues with COVID-19.

Viral Load and CD4+ Cell Count Before COVID-19 and After Recovery

The intervals between last tests and follow-up tests for CD4+ cell count and HIV-1 viral load were 9.0 (IQR, 6.0–12.0) months and 12.0 (IQR, 9.0–14.0) months, respectively. And there were no statistically significant difference for the intervals for tests of CD4+ cell count (P = 0.833) and HIV-1 viral load (P = 0.133) between severe and nonsevere groups (Table 1 and see Table 2, Supplemental Digital Content, http://links.lww.com/QAI/B558).

As shown in Table 1, Supplemental Digital Content, http://links.lww.com/QAI/B558 and Figure 1, coinfected patients experienced a statistically insignificant decline of CD4+ cell count after COVID-19 with different severity of COVID-19 and with continuous ART (all P > 0.05). There was a trend of increasing HIV-1 viral load for coinfected patients overall (P = 0.051), and the number of coinfected patients with HIV-1 viral load ≥20 copies/mL increased significantly after recovery (P = 0.008). The trend of increasing viral load was observed in coinfected patients with severe/critical COVID-19 but not in nonsevere COVID-19 (Table 1, Supplemental Digital Content, http://links.lww.com/QAI/B558). When excluding those with ART discontinuation, the trend of increasing viral load still existed (Figure 1).

Figure 1.

The virologic and immunologic outcomes for HIV patients before COVID-19 and after recovery. A, Presenation of immunologic outcomes, (B) presentation of virologic outcomes. Twenty-eight of 33 survived coinfected patients participated in our follow-up survey; one of 28 coinfected patients initiated ART against HIV infection at onset of COVID-19, thus no HIV-1 viral load and CD4+ cell count were available before COVID-19. Finally, a total of 27 coinfected patients were included in the scatter diagram before COVID-19 and 28 included in the scatter diagram after recovery. To facilitate presentation, log10 copies/mL was calculated based on raw data where HIV-1 viral load <20 copies/mL was regarded as 20 copies/mL.

Toxic Side Effects of ART Against HIV Infection Before COVID-19 and After Recovery

Limited change was found in leukocytes, hemoglobin, blood platelets, serum creatinine, total bilirubin, ALT (all P > 0.05), except for aspartate aminotransferase (AST) and AST/ALT ratio (see Table 1, Supplemental Digital Content, http://links.lww.com/QAI/B558). There was a statistically and significantly increased proportion of abnormal AST and AST/ALT ratio in both nonsevere group (P = 0.002 and P = 0.001, respectively) and severe group (P = 0.008 and P = 0.008, respectively).

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