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Sept 9, 2020

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Lauren Richey.jpgHIV Status Did Not Impact COVID-19 Outcomes in Two Matched Cohort Studies in New York City

Reviewed by Lauren Richey, M.D., MPH, FIDSA

Data on the novel coronavirus support that worse outcomes are seen among patients with many pre-existing conditions and immunosuppression, but there is little data on COVID-19 outcomes in people living with HIV (PLWH). Two recent publications provide some insight into outcomes for these patients.

Researchers at NYU Langone Health (Karmen-Tuohy et al.) conducted a retrospective cohort study of 21 PLWH and 42 people without HIV admitted with COVID-19 infection and reported their results in the Journal of Acquired Immune Deficiency Syndromes. They performed one to two matching of patients by admission date, age, body mass index, gender, tobacco history, history of chronic kidney disease, hypertension, diabetes, asthma, chronic obstructive pulmonary disease (COPD), and heart failure. Data were obtained from chart review. Given the matching, the demographics and comorbidities between the groups were similar. In PLWH, median CD4 count was 298, most were undetectable on admission (15 out of 17), and all were on antiretroviral therapy (ART). A greater percentage of PLWH had consolidation, infiltrate, or opacity on initial chest imaging (91% versus 64%), which was statistically significant. Although not statistically significant, PLWH trended towards longer stays and higher rates of intensive care unit (ICU) admission, mechanical ventilation, and mortality or transfer to hospice.

A second study, published in Clinical Infectious Diseases, was performed by Sigel et al. at Mount Sinai Health System in New York City. This retrospective cohort study included 88 PLWH and 405 matched HIV uninfected patients admitted with COVID-19 infections. The patients were matched for age, race, gender, and calendar week of infection to account for temporal changes in COVID-19 management. Data were obtained from chart review. Demographics were similar given the matching algorithm but significant differences were seen in the proportion of PLWH who smoked compared to other patients (55% versus 23%) and in the proportion of PLWH with COPD (10% versus 3%), cirrhosis (6% versus 2%), and history of cancer (17% versus 6%). All PLWH were on ART, 58% had CD4 counts over 200, and 81% were virally suppressed. ICU admission, mechanical ventilation, and mortality were similar among PLWH and the comparison group.

Overall, both studies showed that HIV status did not statistically affect clinical outcomes, although the majority of PLWH were well-controlled patients on ART. The findings may not be applicable to some patient subsets.

(Karmen-Tuohy et al. J Acquir Immune Defic Syndr. 2020;85(1):6-10.)

(Sigel et al. City. Clin Infect Dis. Published online: June 28, 2020.)

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