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A comparison of COVID-19 inpatients by HIV status

Sarah Flannery1, Rebecca Schwartz2, Rehana Rasul3

  • 1Division of Infectious Diseases, Department of Medicine, 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA.

International Journal of STD & AIDS
|June 22, 2021
PubMed

Insights

People living with HIV (PLWH) hospitalized with COVID-19 had similar outcomes to HIV-negative patients. However, PLWH with low CD4 counts or off HIV treatment faced higher mortality, while IL-6 inhibitors showed a protective effect.

Area of Science:

  • Infectious Diseases
  • Virology
  • Public Health

Background:

  • Early COVID-19 pandemic disproportionately affected New York City.
  • People living with HIV (PLWH) represent a vulnerable population with potential comorbidities.
  • Understanding COVID-19 outcomes in PLWH is crucial for targeted healthcare strategies.

Purpose of the Study:

  • To compare in-hospital morbidity and mortality of COVID-19 patients with and without HIV.
  • To identify risk factors for adverse outcomes among hospitalized PLWH with COVID-19.
  • To evaluate the impact of specific treatments on COVID-19 outcomes in PLWH.

Main Methods:

  • Retrospective cohort study comparing COVID-19 inpatients with and without HIV.
  • Analysis of demographic, clinical, and treatment data.
  • Statistical comparison of in-hospital mortality, ICU admission, and ventilator use.

Main Results:

  • No significant difference in ventilator use, ICU admission, or in-hospital mortality between PLWH and HIV-negative patients.
  • PLWH were younger, with higher prevalence of male sex, Black race, malignancies, and chronic liver/renal disease.
  • Among PLWH, viral unsuppression, low CD4% (<14), and not being on HIV treatment were associated with higher mortality.
  • IL-6 inhibitors were associated with lower mortality in PLWH.
  • Certain medications (antifungals, hydroxychloroquine, azithromycin, steroids, vasopressors) were linked to higher mortality in PLWH.

Conclusions:

  • Hospitalized COVID-19 patients with HIV do not experience worse outcomes than the general population.
  • Specific subgroups of PLWH, including those with low CD4 counts or off HIV treatment, are at increased risk.
  • IL-6 inhibitors may improve outcomes for PLWH with COVID-19.
  • Further research is needed to clarify the role of various medications in COVID-19 outcomes for PLWH.

Keywords:
AIDS < viral diseasehuman immunodeficiency virus < viral diseaseviral disease

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