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.

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