COVID-19 More Prevalent Among General vs HIV-Positive Population, Barcelona Study Says

Study results out of Barcelona, Spain, show that people living with HIV (PLWH) may not be at greater risk of contracting coronavirus disease 2019 (COVID-19), reports the journal AIDS, despite their immunocompromised status.

Factors previously suggested as increasing this risk include having a CD4+ T-cell count below 200/mcL and not being on antiretroviral therapy, while other reports suggest ART may actually offer protection against the supposed respiratory illness.

“To our knowledge, this is the first prospective study assessing clinical characteristics and outcome, risk factors, and incidence of symptomatic COVID-19 in a large cohort of PLWH,” the authors stated.

Their prospective, observational, single-center cohort study comprised HIV-positive patients self-reporting possible COVID-19 symptoms between March 1 and May 10, 2020 at Hospital Clinic of Barcelona. They investigated clinical characteristics, possible risk factors of COVID-19 diagnosis and severity, and standardized incidence rate ratios (IRRs) for diagnosed COVID-19 in 2 study cohorts: PLWH (n = 5683) and the general population of Barcelona.

Overall results show that 0.9% (n = 53; 95% CI, 0.7%-1.2%) of the PLWH ultimately received a COVID-19 diagnosis (42 confirmed, 11 probable). Among this group, the median measures were 44 years for age, 618/mcL for CD4+ T cells, and 0.90 for CD4+/CD8+ ratio. Fifty-one were virologically suppressed. Eight (15%) patients has CD4+ T-cell count below 350/mcL and 2 (4%), below 200/mcL.

The most recent CD4+ T-cell counts and viral load measures were from the previous 6 months.

The following lab markers showed possible links to COVID-19 severity among PLWH, compared with the general population:

• Lower median oxygen saturation (P = .0121) and platelet counts (P = .0489)
• Higher median leukocytes (P = .0489), creatinine (P = .0062), lactate dehydrogenase (P = .0232), C reactive protein (P = .0186), procalcitonin (P = .0016), and ferritin (P = .0020)

Sixty-two patients had reported possible COVID-19 symptoms, but 9 tested negative for severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2, the virus that causes COVID-19. The most common COVID-19 symptoms were cough (87%) and fever (82%); the most rare, nausea and vomiting (8%) and diarrhea (31%). A median (interquartile range [IQR]) 4 (IQR, 3-7) days passed between symptom onset and medical consultation.

Study results did not indicate an association between HIV- or antiretroviral-related factors and a greater likelihood of being positive for SARS-CoV-2 or having a more severe form of the disease. Reverse transcription polymerase chain reaction (RT-PCR) used nasal and throat swabs to test for SARS-CoV-2; in cases where RT-PCR was not used, an ELISA IgM/IgA/IgG blood test was performed. The European Centre for Disease Prevention and Control provided the definition for confirmed/probable cases of COVID-19.

A checklist of COVID-19 symptoms was also used for each patient, with hospital admission criteria being having a respiratory rate above 20 bpm, room air oxygen saturation below 95%, and any comorbidity. PLWH also had to have a CD4+ T-cell count below 350/mcL.

Most notably for PLWH compared with the general Barcelona population:

1. The standardized incident rate of confirmed COVID-19 cases was 107 vs 282, respectively, per 10,000 individuals. With a standardized IRR of 0.38 (95% CI, 0.27-0.52; P < .0001), there was a 62% lower rate of confirmed COVID-19 cases in the PLWH cohort.
2. The standardized incident rate of confirmed/probable COVID-19 cases was 136 vs 417, also per 10,000 individuals. With a standardized IRR of 0.33 (95% CI, 0.21-0.50; P < .0001), there was a 67% lower rate of confirmed/probable COVID-19 cases in the PLWH cohort.

“COVID-19 in PLWH had similar clinical characteristics and outcome but a lower incidence than in the general population. We were unable to identify any major role of HIV or antiretroviral factors on the risk or severity,” the authors concluded. “These findings should be confirmed in larger multicenter cohort studies.”

They added that although the clinical characteristics of COVID-19 did not differ between the study cohorts, for PLWH, differential diagnosis for Pneumocystis jiroveci, mycobacterial, or cryptococcal pneumonia should be performed in the presence of cough, fever, bilateral lung infiltrates, and lymphocytopenia.

Limitations to generalization of these study results include the small number of PLWH with diagnosed COVID-19 and the universal standardized care for HIV and COVID-19 that all PLWH received.

Reference

Inciarte A, Gonzalez-Cordon A, Rojas J, et al. Clinical characteristics, risk factors, and incidence of symptomatic coronavirus disease 2019 in a large cohort of adults living with HIV: a single-center, prospective observational study. AIDS. Published online August 7, 2020. doi:10.1097/QAD.0000000000002643