HIV and Covid-19: retrospective analysis of hospitalized patients

Clinical results for PLHIV hospitalized for Covid-19 have shown mixed results. Data from the OpenSAFELY study shows that HIV patients have a 2.9-fold risk of death linked to Covid-19 and in the Isarik cohort, the authors find a hazard ratio of 1.49 in terms of mortality at J28. Via a retrospective multicenter analysis of matched cohorts in the United Kingdom, the aim of this study was to estimate the effect of HIV status on the outcome of hospitalized Covid-19 patients.

Index cases were HIV + patients Covid-19 PCR + hospitalized between 1 st  February and 31 May 2020. The negative patients were matched for PLHIV to a ratio of 3: 1 of 6 sites in England, site hospital, date of test ± 7 days, age ± 5 years, sex. The primary endpoint was patients achieving ≥ 2 points improvement on the WHO 7 point scale or discharge from hospital. Baseline characteristics and outcomes were analyzed by stratified Cox proportional hazards regression. The model was fitted for ethnicity, clinical frailty score, body mass index, baseline hypoxia, duration of symptoms, hypertension, diabetes, malignancy, heart, lung and kidney disease.

68 PLHIV and 181 HIV-negative patients were included out of 6,612 hospitalized patients over the period, in the different sites.

Patients since HIV diagnosis, CD4 at 352 / mm 3 , 97.1% have an undetectable viral load <200 copies / mL and 47.6% were on integrase inhibitors.

In terms of initial characteristics or comorbidities, PLHIV are, compared to subjects not infected with HIV, more frequently with end-stage renal impairment or on dialysis, with Child B or C hepatic impairment, with a higher frailty score, and more often black / other minority.

On the criterion “improvement ≥ 2 points on the WHO 7-point scale or discharge from the hospital”, the results are as follows:

PLHIV had a hazard ratio of 0.57 ( 95 CI  : 0.39-0.85; p = 0.005) of achieving a 2-point improvement or discharge from hospital compared to HIV-negative patients. HIV. On the other hand, no difference in mortality at D28 between the 2 groups.

The effect of HIV status is attenuated (aHR = 0.70; 95 CI  : 0.43-1.17; p = 0.18) after adjustment in the multivariate model with the frailty score (aHR = 0.79; CI 95  : 0.65-0.95; p = 0.011), have an active cancer (aHR = 0.37; CI 95  : 0.17-0.82; p = 0.01) or a BMI < 25 (aHR = 0.46; CI 95  : 0.21-0.99; p = 0.047) having a greater impact on the primary endpoint. In terms of secondary endpoints, there is no difference in death or use of mechanical ventilation or improvement in WHO criteria on D28.

Although PLHIV are less likely to achieve improvement or discharge from hospital, after adjustment, the effect of HIV status is lessened. Increased baseline fragility and active malignant tumors remain associated with poorer outcomes for Covid-19.

Abdoul (assumed name), a homeless and undocumented Moroccan in Spain, has survived since last November without his diabetes medication.

As soon as he came of age, Abdoul decided to leave Morocco to join Spain via the Canary Islands, in order to build a better future. Rescued on November 7 by the emergency services, he stayed for 28 days in the Arguineguín detention center, before being accommodated in a hotel where catering conditions were difficult.

After losing consciousness, he was transported to a health center where he was diagnosed with type II diabetes. In the process, he lost his cell phone and the little money he had. “I fainted up to three times and no one cared about my state of health or provided me with any necessary medication,” he laments.

After repeatedly asking for better treatment, Abdoul, against all odds, tested positive for Covid-19, without any apparent symptoms, then was placed in quarantine for an unusually long period of time.

Last month, a ruptured pipe flooded the new camp he was transferred to with sewage, forcing staff to group them into a single tent, in violation of sanitary protocol. Pushed to leave, he left the center with other residents, before asking to come back. But the authorities at the center refused him, which forced him to return to live on the streets. And it was there that he had a new crisis of diabetes and was taken care of by the center.

Today, Abdoul controls his sugar consumption, takes his tablets regularly. If he was still on the streets, his health problems could very well have cost him his life.

Types, differences and everything you need to know about it

Diabetes mellitus is a class of metabolic diseases all of which have in common high levels of sugar in the blood (glucose) that result from problems with insulin secretion, its action, or both. Usually, blood sugar is controlled by a hormone secreted by the pancreas called insulin. When there is an increase in blood sugar, the pancreas releases insulin to normalize blood sugar. There are mainly two types of diabetes: type 1 and type 2.

Both types are chronic diseases that affect the way blood sugar levels or the regulation of glucose in the body. Glucose is like the fuel that nourishes the cells of the body, but to get into the cells it needs a key which is insulin.

Type 1: People with diabetes of this type do not produce insulin.

Type 2: People with diabetes of this type do not respond to insulin and, later in the disease, often fail to produce enough insulin.

What is insulin?

Insulin is a hormone produced by specialized cells in the pancreas. Insulin is also important to strictly control the level of glucose in the blood.

Insulin treatment:

People with type 2 diabetes may need insulin when their meal plan, weight loss, physical activity, and medications do not reach target blood sugar (sugar) levels. In a progressive disease such as diabetes, insulin injections may be needed to compensate for the decrease in production by the pancreas. Therefore, insulin treatment should never be seen as a failure.

Possible healing:

Type 1: No cure at this time, but lifelong treatment can treat symptoms. Gene therapy, regenerative medicine using stem cells, or pancreatic islet transplantation over time may become an option.

Type 2: Currently no cure, but taking measures can slow progression and manage symptoms. Symptoms can be reduced with gastric bypass in people with severe obesity.

Prevention:

Type 1: It is not yet possible to prevent.

Type 2: A healthy diet with regular exercise should be followed. If prediabetes is diagnosed, follow a doctor’s instructions.

Outlook

Diabetes is a serious illness. For type 1, insulin and other medications can help people manage symptoms and lead normal lives. Although there may be a hereditary link for both types of diabetes, the risks of type 2 diabetes can be reduced and managed by adopting a healthy lifestyle and exercising regularly. Anyone diagnosed with prediabetes should make healthy lifestyle choices to eliminate the risk of developing type 2 diabetes.

Symptoms and treatment of diabetes in cats

How can you tell that your cat may be diabetic? Certain signs can alert …

If your pet drinks and eats a lot more than usual and urinates a lot, he may have diabetes, especially if he is overweight. These symptoms can be accompanied by fairly rapid weight loss. A visit to your veterinarian is essential, because it is better not to let such a situation worsen.

What are the risks ?

If you don’t quickly identify the symptoms, or if you don’t show your cat quickly to your vet, your pet may become dehydrated, vomit, or even go into a coma. He can also develop urinary or kidney disease.

What are the exams to do?

Only a veterinarian can make a diagnosis, based on a blood test and urinalysis. The aim is to detect whether or not there is hyperglycemia, i.e. too high a concentration of sugar in the blood. The urinalysis will determine if your cat has sulfur in the urine. An abdominal ultrasound can determine if the pancreas is also affected.

What are the treatments ?

In some cases, if the diabetes is mild, a change in diet may be enough to regulate your pet’s blood sugar levels. Croquettes are specifically designed for this; they are only available from a veterinarian. They are not found in supermarkets.

An overweight cat will have to lose weight gradually and a skinny cat will have to gain weight, under veterinary control and at its own pace.

Insulin administration in the morning and evening in the form of an injection pen will often be necessary. It is certainly binding, but essential. Hospitalization of the cat in a veterinary clinic will allow the best dosage of insulin therapy at the start of treatment. Thereafter, your cat will have to be brought in every six months for a consultation so that the veterinarian can check if his insulin treatment is still effective or if it needs to be adapted.

Early detection and treatment of diabetes in cats can sometimes prevent insulin intake.