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


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

In This Article


The detailed participant recruitment and survey could be seen in Figure 1, Supplemental Digital Content, The loss to follow-up rate was 15.2%.


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,

As shown in Table 1, Supplemental Digital Content, 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, 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, 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).