Dima Dandachi1, Grant Geiger2, Mary W Montgomery3, Savannah Karmen-Tuohy4, Mojgan Golzy5, Annukka A R Antar6, Josep M Llibre7, Maraya Camazine2, Alberto Díaz-De Santiago8, Philip M Carlucci4, Ioannis M Zacharioudakis9, Joseph Rahimian9, Celestine N Wanjalla10, Jihad Slim11, Folasade Arinze12, Ann Marie Porreca Kratz13, Joyce L Jones6, Shital M Patel14, Ellen Kitchell15, Adero Francis12, Manoj Ray16, David E Koren17, John W Baddley18, Brannon Hill19, Paul E Sax3, Jeremy Chow15. 1. Division of Infectious Diseases, University of Missouri-Columbia, MO. 2. School of Medicine, University of Missouri-Columbia, MO. 3. Department of Infectious Diseases, Brigham and Women's Hospital, Boston, MA. 4. School of Medicine, New York University Grossman School of Medicine, New York, NY. 5. Department of Health Management and Informatics, University of Missouri-Columbia, MO. 6. Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD. 7. Infectious Diseases and Fight AIDS Foundation, University Hospital Germans Trias, Badalona, Spain. 8. Internal Medicine Department, HIV Infection Unit. Puerta de Hierro Majadahonda University Hospital, Madrid, Spain. 9. Division of Infectious Diseases and Immunology, New York University Grossman School of Medicine, New York, NY. 10. Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN. 11. Division of Infectious Diseases, Saint Michael's Medical Center, Newark, NJ. 12. Department of Internal Medicine, Wellstar Health System, Atlanta, GA. 13. Department of Pharmacy, Tower Health, Pennsylvania, PA. 14. Section of Infectious Diseases, Medicine, Baylor College of Medicine, TX. 15. Division of Infectious Diseases, UT Southwestern Medical Center, TX. 16. Division of Infectious Diseases, Santa Clara Valley Health & Hospital System, CA. 17. Department of Pharmacy, Temple University Health System, PA. 18. Division of Infectious Disease, University of Maryland, Baltimore, MD. 19. Department of Pharmacy, University of Arkansas for Medical Sciences, AR.
Abstract
BACKGROUND: People with HIV (PWH) may have numerous risk factors for acquiring Coronavirus disease-19 (COVID-19) and developing severe outcomes, but current data are conflicting. METHODS: Healthcare providers enrolled consecutively by non-random sampling PWH with lab-confirmed COVID-19, diagnosed at their facilities between April 1st and July 1st, 2020. De-identified data were entered into an electronic Research Electronic Data Capture (REDCap). The primary endpoint was severe outcome, defined as a composite endpoint of intensive care unit (ICU) admission, mechanical ventilation, or death. The secondary outcome was the need for hospitalization. RESULTS: 286 patients were included; the mean age was 51.4 years (SD, 14.4), 25.9% were female, and 75.4% were African-American or Hispanic. Most patients (94.3%) were on antiretroviral therapy (ART), 88.7% had HIV virologic suppression, and 80.8% had comorbidities. Within 30 days of positive SARS-CoV-2 testing, 164 (57.3%) patients were hospitalized, and 47 (16.5%) required ICU admission. Mortality rates were 9.4% (27/286) overall, 16.5% (27/164) among those hospitalized, and 51.5% (24/47) among those admitted to an ICU. The primary composite endpoint occurred in 17.5% (50/286) of all patients and 30.5% (50/164) of hospitalized patients. Older age, chronic lung disease, and hypertension were associated with severe outcomes. A lower CD4 count (<200 cells/mm³) was associated with the primary and secondary endpoints. There was no association between the antiretroviral regimen or lack of viral suppression and predefined outcomes. CONCLUSION: Severe clinical outcomes occurred commonly in PWH and COVID-19. The risk for poor outcomes was higher in those with comorbidities and lower CD4 cell counts, despite HIV viral suppression.
BACKGROUND:People with HIV (PWH) may have numerous risk factors for acquiring Coronavirus disease-19 (COVID-19) and developing severe outcomes, but current data are conflicting. METHODS: Healthcare providers enrolled consecutively by non-random sampling PWH with lab-confirmed COVID-19, diagnosed at their facilities between April 1st and July 1st, 2020. De-identified data were entered into an electronic Research Electronic Data Capture (REDCap). The primary endpoint was severe outcome, defined as a composite endpoint of intensive care unit (ICU) admission, mechanical ventilation, or death. The secondary outcome was the need for hospitalization. RESULTS: 286 patients were included; the mean age was 51.4 years (SD, 14.4), 25.9% were female, and 75.4% were African-American or Hispanic. Most patients (94.3%) were on antiretroviral therapy (ART), 88.7% had HIV virologic suppression, and 80.8% had comorbidities. Within 30 days of positive SARS-CoV-2 testing, 164 (57.3%) patients were hospitalized, and 47 (16.5%) required ICU admission. Mortality rates were 9.4% (27/286) overall, 16.5% (27/164) among those hospitalized, and 51.5% (24/47) among those admitted to an ICU. The primary composite endpoint occurred in 17.5% (50/286) of all patients and 30.5% (50/164) of hospitalized patients. Older age, chronic lung disease, and hypertension were associated with severe outcomes. A lower CD4 count (<200 cells/mm³) was associated with the primary and secondary endpoints. There was no association between the antiretroviral regimen or lack of viral suppression and predefined outcomes. CONCLUSION: Severe clinical outcomes occurred commonly in PWH and COVID-19. The risk for poor outcomes was higher in those with comorbidities and lower CD4 cell counts, despite HIV viral suppression.
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