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Elvira Manzano
30 Nov 2020

HIV patients hospitalized for COVID-19 are at a higher risk for mortality than those hospitalized without HIV in a new study reported at HIV Glasgow 2020.

This was the key finding from an analysis of data from the ISARIC WHO Clinical Characterisation Protocol (UK) study.

HIV-positive status was associated with a 63-percent increased risk of death at day 28 in patients hospitalized with COVID-19 from January 17 to June 4, 2020 in the UK. This was particularly evident in HIV-positive patients younger than 70 years old, said lead investigator Dr Anna Maria Geretti, professor of virology and infectious diseases, University of Liverpool in Liverpool, UK. [HIV Glasgow 2020, abstract O422]

The cumulative incidence of mortality at day 28 was 25.2 percent in HIV-positive patients vs 32.1 percent in HIV-negative patients (p=0.12).

Anxiety prompts investigation

Geretti and team investigated whether HIV status is important in COVID-19 outcomes. “This was because of the anxiety manifested by our patients … we wanted to gather evidence-based information that would guide them,” Geretti said.

ISARIC, she said, is a UK-wide consortium of doctors and scientists committed to providing information about COVID-19.  “We applied for access to its very large database, which connects data from all patients hospitalized with either known or suspected COVID-19.”

“This is our first analysis in what will be an ongoing process,” Geretti pointed out. “What is important is that we demonstrated that there is really a need to look more carefully into this population with HIV.”

Twofold risk if younger and obese

Of 47,539 patients in the database, 115 (0.24 percent) were HIV-positive. Of this,  103 (89.6 percent) had a history of antiretroviral treatment (ART).

The HIV patients were younger, with a median age of 55 vs 74 in those without HIV (p<0.001) on admission. HIV patients also had a higher prevalence of obesity, moderate-to-severe liver disease, higher lymphocyte counts, and C-reactive protein, plus a host of systemic symptoms. No differences were noted between the two groups in terms of respiratory rate, oxygen need, or presence of chest infiltrates.

When stratified by age, the mortality rate was higher in younger HIV-positive patients than those HIV-negative. “HIV patients younger than 70 years old had a twofold risk of mortality. These are people who had diabetes with complications and are likely obese.”

Mortality at day 28 was significantly higher in HIV-positive patients <50 years of age (p=0.004) and those 50– 59 years of age (p=0.05).

To validate their findings, Geretti and team plan to expand their data set to 100 more patients. “We need greater numbers … we hope the research community will be stimulated to take a closer look at this information, and merge other data … we need to tease out what factors are causing this increased risk of mortality in this group,” Geretti said. “As HIV patients seem to be at increased risk, HIV status should be factored into the clinical management.”

What if HIV status is not known to COVID-19 patients? “Run a test. That would be good practice,” she recommended.

 

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