COVID-19: low CD4, high comorbidity linked to poor clinical outcomes with HIV

  • Dandachi D & al.
  • Clin Infect Dis
  • 9 Sep 2020

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • People with HIV (PWH) have outcomes for severe COVID-19 disease that are comparable to the general population's.
  • However, several HIV-specific risk factors are prognostic for severe COVID-19.

Why this matters

  • To mitigate a COVID-19 effect, close observation and monitoring are warranted for patients with advanced HIV immunosuppression, especially in areas with ongoing SARS-CoV-2 transmission.

Key results

  • n=286; mean age, 51.4 years.
  • At COVID-19 diagnosis:
    • 77.9% (180/231) had HIV >5 years,
    • 88.7% (235/265) were virologically suppressed,
    • 94.3% (263/279) were on antiretroviral therapy, and
    • 26.9% (77) had ≥3 comorbidities.
  • 57.3% (164) were hospitalized at ≤30 days following positive SARS-CoV-2 test.
    • 28.7% (47) required ICU admission.
    • Median interval to admission: 2.0 (interquartile range [IQR], 0.0-9.0) days from testing.
  • Outcomes:
    • 22.6% (37) required invasive mechanical ventilation. 
    • 16.5% died (median, 16 [IQR, 8-24] days from testing).
  • On multivariate analysis, independent predictors of hospitalization (ORs):
    • Higher age: 1.04 (P=.01).
    • Lower CD4: 5.22 (P=.02). 
    • Chronic kidney disease: 5.12 (P<.01>
    • Chronic lung disease: 4.54 (P<.01>
    • >3 comorbidities: 4.56 (P<.01>
  • Factors associated (ORs) with severe disease:
    • Older age: 1.04 (P=.02).
    • Hypertension: 2.44 (P=.03). 
    • Chronic lung disease: 3.65 (P<.01>
    • >3 comorbidities: 5.09 (P=.04).

Study design

  • Retrospective, multicenter registry evaluation of severe clinical outcomes in PWH with lab-confirmed COVID-19.
  • Funding: None.

Limitations

  • Selection bias.
  • Missing confounders.
  • Cause of death unverified.