Outcomes of patients with HIV and COVID-19 co-infection: a systematic review and meta-analysis

Effect of HIV Status and Charlson Comorbidity Index on COVID-19 Clinical Outcomes in a Case-Control Study

OBJECTIVES

During the course of the coronavirus disease 2019 (COVID-19) pandemic, numerous comorbidities were identified as risk factors for increased morbidity and mortality. Few studies have examined human immunodeficiency virus (HIV) and COVID-19 co-infection and the impact of HIV on COVID-19 outcomes. In this study, we compared outcomes of people living with HIV with COVID-19 with a control group to examine outcomes.

METHODS

We identified 45 people living with HIV admitted with COVID-19 to one of three large healthcare systems in Memphis, Tennessee, between March 1 and October 31, 2020. We matched the people living with HIV in a 1:1 fashion to a control group of COVID-19-positive patients without a recorded history of HIV and compared clinical outcomes. Nine pairs were not able to be optimally matched, so a sensitivity analysis was completed by repeating the same analyses in the primary analysis while excluding the nine mismatched pairs.

RESULTS

Patients did not differ significantly in demographic variables due to the matching algorithm, and there was no significant difference in measured outcomes between people living with HIV and controls. A CD4 count of <200 cells per microliter was not significantly associated with increased morbidity or mortality. Controlling for HIV status, an elevated Charlson Comorbidity Index score of >3 was associated with increased intubation (P = 0.02), vasopressor use (odds ratio [OR] 4.81, P = 0.04), intensive care unit level of care (OR 4.37, P = 0.007), mortality (OR 7.14, P = 0.02), and length of overall hospital stay in days (P = 0.004).

CONCLUSIONS

We found no difference in outcomes of people living with HIV in comparison to matched controls based on HIV status but found that an increased Charlson Comorbidity Index score led to increased morbidity and mortality regardless of HIV status.

Relationships Among COVID-19-Related Service Uptake, HIV Status, Drug Use, and COVID-19 Antibody Status Among HIV Testing Intervention Participants in KwaZulu-Natal, South Africa

People living with HIV (PLWH) and people who use drugs are vulnerable populations who may face barriers to accessing health services and may have irregularities in immune function. People with undiagnosed HIV infection may be particularly likely to have compromised immune function. However, research about whether/how HIV status is related to COVID-19-related health outcomes has been equivocal, and research on the predictors of COVID-19-related health service access/uptake has been limited in Sub-Saharan African settings. Among 470 participants of a peer-recruitment-based HIV-testing intervention in KwaZulu-Natal, we examined whether HIV status and/or hard drug use were associated with uptake of COVID-19 testing and vaccination, and whether they moderated the relationship between COVID-19 vaccination status and COVID-19 IgG antibody status. Women were significantly more likely than men to report testing for COVID-19 (OR = 1.84; p = 0.002) and being vaccinated (OR = 1.79; p = 0.002). Neither HIV status nor drug use was associated with likelihood of getting tested or vaccinated. Vaccinated participants (90% of whom obtained vaccines more than 6 months before the study) were significantly more likely to test positive for COVID-19 IgG antibodies (OR = 6.86; p < 0.0005). This relationship held true for subgroups of PLWH and participants with previously undiagnosed/uncontrolled HIV infection, and was not moderated by HIV status or hard drug use. These findings may suggest that both people who use drugs and PLWH were served as well as other people by KwaZulu-Natal's COVID-19 response. However, gender-based disparities in COVID-19 service uptake suggest that special care should be taken during future COVID-19 outbreaks or other new epidemics to improve access to related healthcare services among men in this region.

Immunogenicity and Determinants of Antibody Response to the BNT162b2 mRNA Vaccine: A Longitudinal Study in a Cohort of People Living with HIV

BACKGROUND

The COVID-19 pandemic posed significant challenges worldwide, with SARS-CoV-2 vaccines critical in reducing morbidity and mortality. This study evaluates the immunogenicity and antibody persistence of the BNT162b2 vaccine in people living with HIV (PLWH).

METHODS

We monitored anti-SARS-CoV-2 Spike IgG concentration in a cohort of PLWH at five time points (T0-T4) using chemiluminescent microparticle immunoassays (CMIAs) at the baselined both during and after vaccination. In severely immunocompromised individuals, a boosting dose was recommended, and participants and IgG concentration were measured in the two subgroups (boosted and not boosted).

RESULTS

In total, 165 PLWH were included, and 83% were male with a median age of 55 years (IQR: 47-62). At T1, 161 participants (97.6%) showed seroconversion with a median of IgG values of 468.8 AU/mL (IQR: 200.4-774.3 AU/mL). By T2, all subjects maintained a positive result, with the median anti-SARS-CoV-2 Spike IgG concentration increasing to 6191.6 AU/mL (IQR: 3666.7-10,800.8 AU/mL). At T3, all participants kept their antibody levels above the positivity threshold with a median of 1694.3 AU/mL (IQR: 926.3-2966.4 AU/mL). At T4, those without a booster dose exhibited a marked decrease to a median of 649.1 AU/mL (IQR: 425.5-1299.8 AU/mL), whereas those with a booster experienced a significant increase to a median of 13,105.2 AU/mL (IQR: 9187.5-18,552.1 AU/mL). The immune response was negatively influenced by the presence of dyslipidaemia at T1 (aOR 4.75, 95% CI: 1.39-16.20) and diabetes at T3 (aOR 7.11, 95% CI: 1.10-46.1), while the use of protease inhibitors (aORs 0.06, 95% CI: 0.01-0.91) and being female (aOR 0.02, 95% CI: 0.01-0.32) at T3 were protective factors.

CONCLUSIONS

The immunogenicity of the BNT162b2 vaccine in PLWH has been confirmed, with booster doses necessary to maintain high levels of anti-SARS-CoV-2 Spike IgG antibodies, especially in patients with comorbidities. These findings underline the importance of a personalized vaccination strategy in this population.

When Pandemics Collide: Actionable Lessons in HIV Prevention, Treatment and Care During the Era of COVID-19

The articles in this special issue of AIDS and Behavior focus on the collision between HIV/AIDS and COVID-19 as intersecting pandemics that profoundly impacted communities globally. This editorial highlights the complex interplay between these two public health crises. The pandemic disrupted access to HIV prevention, testing, and treatment services, potentially jeopardizing decades of progress. Mental health challenges and social vulnerability among people living with HIV (PWH) were exacerbated, with preexisting health disparities amplified, disproportionately affecting marginalized populations. However, despite these challenges, the pandemic also spurred innovation and adaptation in HIV prevention and care, with increased use of telehealth and other modalities. The enduring and actionable lessons learned from the collision of HIV and COVID-19 pandemics can prepare us for the next public health challenge with two calls for action. First, we call for integrated and equitable responses that address the multifaceted challenges faced by individuals and communities affected by HIV in the post-COVID-19 era. Second, we call for a strengthened commitment to building resilient health systems and community-engaged interventions that can withstand future challenges.

Outcomes of Patients Living with HIV Hospitalized due to COVID-19: A 3-Year Nationwide Study (2020-2022)

Scientific reports on the association between human immunodeficiency virus (HIV) in patients with COVID-19 and mortality have not been in agreement. In this nationwide study, we described and analyzed the demographic and clinical characteristics of people living with HIV (PLWH) and established that HIV infection is a risk factor for mortality in patients hospitalized due to COVID-19. We collected data from the National Hospital Data Information System at Hospitalization between 2020 and 2022. We included patients admitted to the hospital with a diagnosis of COVID-19. We established a cohort of patients with PLWH and compared them to patients without HIV (non-PLWH). For multivariate analyses, we performed binary logistic regression, using mortality as the dependent variable. To improve the interpretability of the results we also applied penalized regression and random forest, two well-known machine-learning algorithms. A broad range of comorbidities, as well as sex and age data, were included in the final model as adjusted estimators. Our data of 1,188,160 patients included 6,973 PLWH. The estimated hospitalization rate in this set was between 1.43% and 1.70%, while the rate among the general population was 0.83%. Among patients with COVID-19, HIV infection was a risk factor for mortality with an odds ratio (OR) of 1.25 (95% CI, 1.14-1.37, p < 0.001). PLWH are more likely to be hospitalized due to COVID-19 than are non-PLWH. PLWH are 25% more likely to die due to COVID-19 than non-PLWH. Our results highlight that PLWH should be considered a population at risk for both hospitalization and mortality.

Trends in HIV incidence and mortality across Bharat (India) after the emergence of COVID-19

BACKGROUND

Human immunodeficiency virus (HIV) is a sexually transmitted infection impacting populations worldwide. While there have been major improvements in controlling HIV over recent years, the COVID-19 pandemic may have potentially resulted in major interruptions to this control of HIV. Bharat (India) is a country that has been greatly impacted by the COVID-19 pandemic, and we aimed to analyse the trends in HIV control since the start of the pandemic.

METHODS

In this study we evaluated changes in rates of HIV incidence and mortality across Bharat for the years both before, and after, the start of the COVID-19 pandemic. Percent and absolute changes were determined, and thereafter, both bivariate and multi linear regression was conducted to evaluate the relationship between COVID-19 burden and changes in HIV epidemiology across the nation.

RESULTS

It was shown that, despite the COVID-19 pandemic, annual incidence and deaths of HIV/AIDS have both decreased across Bharat. From 2019-2021, in Bharat, the total number of new HIV cases annually decreased by 9.03%, and the total number of HIV/AIDS deaths annually decreased by 28.82%. A similar trend was shown across most states/union territories; however, there were notable exceptions (such as Karnataka, Bihar, and Assam) where the rates have instead increased.

CONCLUSIONS

Our analysis has demonstrated that government efforts to control the HIV/AIDS epidemic have not been greatly impacted across the majority of Bharat since the emergence of COVID-19. The reduction in annual HIV/AIDS deaths in the country has been better than the world average, and the improvements from the period of 2019 to 2021 were greater than those from 2017 to 2019. Regardless, there are regions in the nation where the epidemic has instead worsened during this period.

SARS-CoV-2 Variants and Clinical Outcomes of Special Populations: A Scoping Review of the Literature

The ongoing COVID-19 pandemic has significantly impacted special populations, including immunocompromised individuals, people living with HIV (PLWHIV), pediatric patients, and those with chronic liver disease (CLD). This scoping review aims to map the clinical outcomes of these vulnerable groups when infected with various SARS-CoV-2 variants. The review identifies trends and patterns, noting that early variants, such as Alpha and Delta, are associated with more severe outcomes, including higher hospitalization and mortality rates. In contrast, the Omicron variant, despite its increased transmissibility, tends to cause milder clinical manifestations. The review highlights the necessity for ongoing surveillance and tailored healthcare interventions due to the heterogeneity of patient populations and the evolving nature of the virus. Continuous monitoring and adaptive healthcare strategies are essential to mitigate the impact of COVID-19 on these high-risk groups.

The association of sociodemographic characteristics and comorbidities with post-acute sequelae of SARS-CoV-2 in a Medicaid managed care population with and without HIV

Understanding how post-acute sequelae of SARS-CoV-2 infection (PASC) affects communities disproportionately affected by HIV is critically needed. This study aimed to identify the prevalence of PASC symptoms among Medicaid enrollees at risk for or living with HIV. Through a web survey, we received 138 valid responses from Medicaid-managed plan members who had received a COVID diagnosis. Participants' mean age was 45.4 years (SD = 11.9) and most were non-Hispanic Black (43.5%) or Hispanic (39.1%). Almost thirty-two percent reported inadequate incomes and 77.5% were HIV-positive. In the overall population, the frequently reported symptoms included neck/back/low back pain, brain fog/difficulty concentrating, bone/joint pain, muscle aches, and fatigue. Findings indicate that there is no statistically significant difference in the prevalence and intensity of PASC symptoms lasting 6 months or more between individuals living with and without HIV. Multiple regression analysis found that the number of PASC symptoms 6 months or longer was independently associated with inadequate incomes and comorbidities (cardiac problems, cancer, fibromyalgia) (R2 = .34). Those with inadequate incomes and comorbidities have more numerous PASC symptoms. Implications for health care delivery and long-term COVID services will be discussed.

Immunogenicity of the Monovalent Omicron XBB.1.5-Adapted BNT162b2 COVID-19 Vaccine in People Living with HIV (PLWH)

While SARS-CoV-2 has transitioned to an endemic phase, infections caused by newly emerged variants continue to result in severe, and sometimes fatal, outcomes or lead to long-term COVID-19 symptoms. Vulnerable populations, such as PLWH, face an elevated risk of severe illness. Emerging variants of SARS-CoV-2, including numerous Omicron subvariants, are increasingly associated with breakthrough infections. Adapting mRNA vaccines to these new variants may offer improved protection against Omicron for vulnerable individuals. In this study, we examined humoral and cellular immune responses before and after administering adapted booster vaccinations to PLWH, alongside a control group of healthy individuals. Four weeks following booster vaccination, both groups exhibited a significant increase in neutralizing antibodies and cellular immune responses. Notably, there was no significant difference in humoral immune response between PLWH and the healthy controls. Immune responses declined rapidly in both groups three months post vaccination. However, PLWH still showed significantly increased neutralizing antibody titers even after three months. These findings demonstrate the efficacy of the adapted vaccination regimen. The results suggest that regular booster immunizations may be necessary to sustain protective immunity.

COVID-19 Vaccine Acceptance and Hesitancy among People Living with HIV: Review and Meta-Analysis

This study aims to estimate the COVID-19 vaccine acceptance and hesitancy among people living with HIV (PLWHA). A search for observational studies was conducted in five databases and preprinted literature. Summary estimates were pooled using a random effects model and meta-regression. Of 150 identified studies, 31 were eligible (18,550 PLWHA). The weighted prevalence of COVID-19 vaccine hesitancy overall was 29.07% among PLWHA (95%CI = 24.33-34.32; I² = 98%,) and that of vaccine acceptance was 68.66% (95%CI = 62.25-74.43; I² = 98%). Higher hesitancy prevalence was identified in low/lower-middle income countries (35.05; 95% CI = 19.38-54.78). The heterogeneity was explained by the risk of bias, region, and year of data collection. The findings conclude that the COVID-19 vaccine hesitancy rate remains high, especially in low-income countries. Evidence-informed interventions aimed at increasing COVID-19 vaccine acceptance at the national and individual levels ought to be designed to increase COVID-19 vaccine acceptance among PLWHA.

Utilizing Feline Lentiviral Infection to Establish a Translational Model for COVID-19 in People with Human Immunodeficiency Virus Infection

People living with human immunodeficiency virus (PLWH) are a significant population globally. Research delineating our understanding of coinfections in PLWH is critical to care for those navigating infection with other pathogens. The recent COVID-19 pandemic underscored the urgent need for studying the effects of SARS-CoV-2 infections in therapy-controlled and uncontrolled immunodeficiency viral infections. This study established the utility of a feline model for the in vivo study of coinfections. Domestic cats are naturally infected with SARS-CoV-2 and Feline Immunodeficiency Virus, a lentivirus molecularly and pathogenically similar to HIV. In this study, comparisons are made between FIV-positive and FIV-negative cats inoculated with SARS-CoV-2 (B.1.617.2.) in an experimental setting. Of the FIV+ cats, three received Zidovudine (AZT) therapy in the weeks leading up to SARS-CoV-2 inoculation, and two did not. SARS-CoV-2 viral RNA was quantified, histopathologic comparisons of respiratory tissues were made, and T-cell populations were analyzed for immune phenotype shifts between groups. CD4+ T lymphocyte responses varied, with FIV+-untreated cats having the poorest CD4+ response to SARS-CoV-2 infection. While all cats had significant pulmonary inflammation, key histopathologic features of the disease differed between groups. Additionally, viral genomic analysis was performed, and results were analyzed for the presence of emerging, absent, amplified, or reduced mutations in SARS-CoV-2 viral RNA after passage through the feline model. Positive selection is noted, especially in FIV+ cats untreated with AZT, and mutations with potential relevance were identified; one FIV+-untreated cat had persistent, increasing SARS-CoV-2 RNA in plasma five days post-infection. These findings and others support the utility of the feline model for studying coinfection in people with HIV and highlight the importance of antiretroviral therapy in clearing SARS-CoV-2 coinfections to minimize transmission and emergence of mutations that may have deleterious effects.

COVID-19 Vaccines and COVID-19 in People Living with HIV

Objective

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread rapidly around the world, and COVID-19 and HIV co-infection also became common. In this study, we aimed to investigate the impact of vaccination preferences and vaccination rates on the severity of COVID-19 in patients with HIV co-infection.

Materials and Methods

People living with HIV who were followed in our hospital during the COVID-19 pandemic (January 2020- December 2022) were retrospectively included in the study. The diagnosis of COVID-19 was made by detecting SARS-CoV-2 RNA in nasopharyngeal swab specimens using real-time reverse transcriptase-polymerase chain reaction (rRT-PCR). Patients requiring hospital admission were classified as severe. The patient's demographics and vaccination status were collected from the hospital data system.

Results

Our study included 205 patients using antiretroviral therapy for HIV. The mean day count between the last vaccine date and SARS-CoV-2 PCR positivity was 163 days in the Comirnaty® group,149 days in the CoronaVac® group, and 154 days in the mixed-vaccinated group. Those vaccinated with Comirnaty® were statistically significantly less infected with COVID-19 after vaccination (p<0.05).

Conclusion

The course and the outcomes of COVID-19 among SARS-CoV-2 vaccinated people living with HIV, especially with well-controlled HIV infection, seem to be similar to people living without HIV.

Clinical Outcomes of Coronavirus Disease 2019 in People Living With Human Immunodeficiency Virus in South Korea: A Nationwide Population-Based Cohort Study

BACKGROUND

We aimed to compare the epidemiological and clinical characteristics of coronavirus disease 2019 (COVID-19) in people living with human immunodeficiency virus (HIV) (PLWH) with those in people living without HIV (PLWoH).

METHODS

This nationwide descriptive epidemiological study was conducted in South Korea between January 2020 and February 2022. The National Health Insurance claim data, comprising the data of the entire Korean population, were collected through the Health Insurance Review and Assessment Service.

RESULTS

Among 3,653,808 individuals who were diagnosed with COVID-19, 1311 (0.04%) were PLWH. All PLWH received antiretroviral therapy, and 26.47% had more than one underlying disease other than HIV infection. The overall in-hospital mortality rates of PLWH and PLWoH were 0.76% and 0.25%, respectively (P = 0.002). According to the Cox proportional hazard model, no significant difference was observed in the in-hospital mortality rate (hazard ratio [HR]: 1.80, 95% confidence interval [CI]: 0.70-4.67) between the PLWH and PLWoH. However, progression to severe or critical COVID-19 was more common in PLWH (HR: 2.70, 95% CI: 1.37-5.33). In PLWH diagnosed with COVID-19, a multivariable Cox regression analysis found old age (≥ 60 years) (HR: 6.9, 95% CI: 2.57-18.56) and diabetes mellitus (HR: 5.13, 95% CI: 2.02-13.00) as the independent risk factors for severe or critical COVID-19.

CONCLUSIONS

PLWH had a significantly higher risk of developing severe or critical COVID-19 compared with PLWoH. Our findings suggest the need for implementing tailored strategies to decrease the impact of COVID-19 on PLWH.

Low COVID-19 vaccine uptake in people living with HIV and those with hypertension and diabetes without HIV at Mbarara and Masaka regional referral hospitals: A cross-sectional survey

Chronic diseases such as HIV, hypertension, and diabetes increase the risk of severe coronavirus disease 2019 (COVID-19) and death. Thus, COVID-19 vaccine uptake data among these priority populations are needed to inform immunization programs. We assessed COVID-19 vaccine uptake among people living with HIV (PLWH) and those with hypertension/diabetes without HIV (PWoH) in Southwestern and Southcentral Uganda and determined factors influencing vaccination. We conducted a cross-sectional study from January to April 2023. We enrolled a random sample of participants aged 18 years and older seeking HIV, hypertension, or diabetes care at two regional referral hospitals (RRHs) in Mbarara and Masaka in Uganda. Using vaccination records abstraction and interviewer-administered questionnaires, we collected data on COVID-19 vaccine uptake, sociodemographic data, and reasons for non-uptake in unvaccinated persons. We compared COVID-19 vaccination uptake between PLWH and PWoH and applied modified Poisson regression to determine sociodemographic factors associated with vaccine uptake. The reasons for non-vaccine uptake were presented as percentages. Of the 1,376 enrolled participants, 65.6% were fully vaccinated against COVID-19. Vaccination coverage was 65% among PWLH versus 67% among PWoH. Higher education attainment and older age were associated with COVID vaccination. Participants with secondary education and those aged ≥50 years achieved >70% coverage. Fear of side effects was the most cited reason (67%) for non-vaccination among 330 unvaccinated participants, followed by vaccine mistrust (24.5%). People with chronic diseases in Southwestern Uganda had slightly lower than 70% COVID-19 vaccine coverage as recommended by WHO. Higher educational attainment and older age were linked to increased vaccine uptake. However, mistrust and fear of vaccine side effects were the main reasons for non-vaccination. To increase COVID-19 vaccine uptake, programs must reach those with lower educational attainment and younger age groups, and address the fear of vaccine side effects and mistrust among persons with underlying diseases in Uganda.

The changing landscape of HIV-associated kidney disease

The HIV epidemic has devastated millions of people globally, with approximately 40 million deaths since its start. The availability of antiretroviral therapy (ART) has transformed the prognosis of millions of individuals infected with HIV such that a diagnosis of HIV infection no longer automatically confers death. However, morbidity and mortality remain substantial among people living with HIV. HIV can directly infect the kidney to cause HIV-associated nephropathy (HIVAN) - a disease characterized by podocyte and tubular damage and associated with an increased risk of kidney failure. The reports of HIVAN occurring primarily in those of African ancestry led to the discovery of its association with APOL1 risk alleles. The advent of ART has led to a substantial decrease in the prevalence of HIVAN; however, reports have emerged of an increase in the prevalence of other kidney pathology, such as focal segmental glomerulosclerosis and pathological conditions associated with co-morbidities of ageing, such as hypertension and diabetes mellitus. Early initiation of ART also results in a longer cumulative exposure to medications, increasing the likelihood of nephrotoxicity. A substantial body of literature supports the use of kidney transplantation in people living with HIV, demonstrating significant survival benefits compared with that of people undergoing chronic dialysis, and similar long-term allograft and patient survival compared with that of HIV-negative kidney transplant recipients.

Factors Associated With COVID-19 Vaccination Among Racial/Ethnic Minority Groups With HIV in South Florida

BACKGROUND

Racial/ethnic minority groups with HIV in the United States are particularly vulnerable to COVID-19 consequences and can significantly benefit from increased uptake of COVID-19 vaccines. This study identified factors associated with full COVID-19 vaccination among people with HIV.

SETTING

Ryan White HIV/AIDS Program in Miami-Dade County, FL.

METHODS

Data were collected from 299 Ryan White HIV/AIDS Program adult clients during January-March 2022 using a cross-sectional phone survey. Multivariable logistic regression was used to estimate adjusted odds ratios (aORs) with 95% confidence intervals (CIs). All analyses were weighted to be representative of the race/ethnicity and sex distribution of clients in the Ryan White HIV/AIDS Program.

RESULTS

Eighty-four percent of participants were fully vaccinated with a primary vaccine series; stratified by race/ethnicity, the percentages were 88.9% of Hispanic, 72.0% of black/African American, and 67.5% of Haitian participants. Fully vaccinated participants were less likely to be black/African American than Hispanic (aOR = 0.18; 95% CI: 0.05 to 0.67) and more likely to not endorse any misconceptions about COVID-19 vaccines (aOR = 8.26; 95% CI: 1.38 to 49.64), to report encouragement to get vaccinated from sources of information (aOR = 20.82; 95% CI: 5.84 to 74.14), and to perceive that more than 50% of their social network was vaccinated (aOR = 3.35; 95% CI: 1.04 to 10.71). Experiences of health care discrimination, structural barriers to access vaccines, and recommendations from HIV providers were not associated with full vaccination.

CONCLUSIONS

These findings highlight the importance of delivering accurate and positive messages about vaccines and engaging social networks to promote COVID-19 vaccination among people with HIV. This information can be leveraged to promote uptake of subsequent boosters and other recommended vaccines.

Factors associated with the worsening of COVID-19 symptoms among cohorts in community- or home-isolation care in southern Thailand

Introduction

This study aimed to investigate factors associated with time-to-referral due to worsening symptoms in patients with laboratory-confirmed COVID-19 in southern Thailand. While underlying diseases have been evaluated to assess COVID-19 severity, the influence of vaccinations and treatments is also crucial.

Methods

A cohort of 8,638 patients quarantined in home or community isolation with laboratory-confirmed COVID-19 was analyzed. Survival analysis and the Cox proportional hazard ratio were employed to assess factors influencing time-toreferral.

Results

Age ≥ 60 years, neurologic disorders, cardiovascular disease, and human immunodeficiency virus infection were identified as significant risk factors for severe COVID-19 referral. Patients who received full- or booster-dose vaccinations had a lower risk of experiencing severe symptoms compared to unvaccinated patients. Notably, individuals vaccinated during the Omicron-dominant period had a substantially lower time-to-referral than those unvaccinated during the Delta-dominant period. Moreover, patients vaccinated between 1 and 6 months prior to infection had a significantly lower risk of time-to-referral than the reference group.

Discussion

These findings demonstrate early intervention in high-risk COVID-19 patients and the importance of vaccination efficacy to reduce symptom severity. The study provides valuable insights for guiding future epidemic management strategies and optimising patient care during infectious disease outbreaks.

[Clinical courses and costs for hospitalizations of potentially immunocompromised COVID-19 patients in Germany]

BACKGROUND

 Patients at increased risk of inadequate immune response to COVID-19 vaccinations due to their underlying disease or therapy are potentially vulnerable to severe COVID-19 courses. The aim is to assess the population size, clinical courses and hospitalization costs of these patients in Germany.

METHODS

 This retrospective cohort study is based on extrapolations of a representative sample of statutory health insurance (SHI) claims data from 2020. Clinical COVID-19 courses, hospitalization costs and durations are compared between the insured group at increased risk for inadequate immune response to COVID-19 vaccinations (risk group) and the insured group without this risk.

RESULTS

 There are approximately 1.82 million SHI-insured individuals in the risk group, of whom an estimated 240 000 insured individuals do not develop a humoral immune response after 3 COVID-19 vaccinations. The risk group shows higher proportions with COVID-19 (relative risk [RR] 1.21; 95 % confidence interval [95 % CI] 1.20-1.23), hospitalizations for COVID-19 (RR 3.40; 95 % CI 3.33-3.48), hospitalizations for COVID-19 with intensive care treatment (RR 1.36; 95 % CI 1.30-1.42), and mortality (RR 5.14; 95 % CI 4.97-5.33) compared with the group without risk. In addition, hospitalizations in the risk group are on average 18 % longer (15.36 days vs. 13.00 days) and 19 % more expensive (12 371 € vs. 10 410 €). Expected hospitalization costs in the risk group are four times greater than in the group without risk (4115 € vs. 1017 €).

CONCLUSIONS

 The risk group is vulnerable to COVID-19 and requires additional resources in the German hospital sector. This results in a need for further protective measures. Further studies are needed to evaluate the impact of different viral variants, active and passive immunizations, and therapies on clinical COVID-19 courses and their costs.

Trends in COVID-19 admissions and deaths among people living with HIV in South Africa: analysis of national surveillance data

BACKGROUND

In 2021, the HIV prevalence among South African adults was 18% and more than 2 million people had uncontrolled HIV and, therefore, had increased risk of poor outcomes with SARS-CoV-2 infection. We investigated trends in COVID-19 admissions and factors associated with in-hospital COVID-19 mortality among people living with HIV and people without HIV.

METHODS

In this analysis of national surveillance data, we linked and analysed data collected between March 5, 2020, and May 28, 2022, from the DATCOV South African national COVID-19 hospital surveillance system, the SARS-CoV-2 case line list, and the Electronic Vaccination Data System. All analyses included patients hospitalised with SARS-CoV-2 with known in-hospital outcomes (ie, who were discharged alive or had died) at the time of data extraction. We used descriptive statistics for admissions and mortality trends. Using post-imputation random-effect multivariable logistic regression models, we compared characteristics and the case fatality ratio of people with HIV and people without HIV. Using modified Poisson regression models, we compared factors associated with mortality among all people with COVID-19 admitted to hospital and factors associated with mortality among people with HIV.

FINDINGS

Among 397 082 people with COVID-19 admitted to hospital, 301 407 (75·9%) were discharged alive, 89 565 (22·6%) died, and 6110 (1·5%) had no recorded outcome. 270 737 (68·2%) people with COVID-19 had documented HIV status (22 858 with HIV and 247 879 without). Comparing characteristics of people without HIV and people with HIV in each COVID-19 wave, people with HIV had increased odds of mortality in the D614G (adjusted odds ratio 1·19, 95% CI 1·09-1·29), beta (1·08, 1·01-1·16), delta (1·10, 1·03-1·18), omicron BA.1 and BA.2 (1·71, 1·54-1·90), and omicron BA.4 and BA.5 (1·81, 1·41-2·33) waves. Among all COVID-19 admissions, mortality was lower among people with previous SARS-CoV-2 infection (adjusted incident rate ratio 0·32, 95% CI 0·29-0·34) and with partial (0·93, 0·90-0·96), full (0·70, 0·67-0·73), or boosted (0·50, 0·41-0·62) COVID-19 vaccination. Compared with people without HIV who were unvaccinated, people without HIV who were vaccinated had lower risk of mortality (0·68, 0·65-0·71) but people with HIV who were vaccinated did not have any difference in mortality risk (1·08, 0·96-1·23). In-hospital mortality was higher for people with HIV with CD4 counts less than 200 cells per μL, irrespective of viral load and vaccination status.

INTERPRETATION

HIV and immunosuppression might be important risk factors for mortality as COVID-19 becomes endemic.

FUNDING

South African National Institute for Communicable Diseases, the South African National Government, and the United States Agency for International Development.

HIV Testing Disruptions and Service Adaptations During the COVID-19 Pandemic: A Systematic Literature Review

Access to treatment and care in safe clinical settings improves people's lives with HIV. The COVID-19 pandemic disrupted vital HIV programs and services, increasing the risk of adverse health outcomes for people with HIV and HIV transmission rates in the community. This systematic literature review provides a meta-analysis of HIV testing disruptions and a synthesis of HIV/AIDS services adapted during COVID-19. We searched scholarly databases from 01 January 2020 to 30 June 2022 using key terms on HIV testing rates and services during the COVID-19 pandemic. The process of how the included articles were identified, selected, appraised, and synthesised was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We included 17 articles that reported changes in HIV testing during the COVID-19 pandemic and 22 that reported adaptations in HIV/AIDS services. We found that HIV testing decreased by 37% during the search period because of the COVID-19 pandemic. Service providers adopted novel strategies to support remote service delivery by expanding community antiretroviral therapy dispensing, setting up primary care outreach points, and instituting multi-month dispensing services to sustain client care. Therefore, service providers and policymakers should explore alternative strategies to increase HIV testing rates impacted by COVID-19 and leverage funding to continue providing the identified adapted services.

A systematic review and meta-analysis of the global prevalence and determinants of COVID-19 vaccine acceptance and uptake in people living with HIV

People living with HIV (PLHIV) are at higher risk of poor outcomes of SARS-CoV-2 infection. Here we report the pooled prevalence of COVID-19 vaccine acceptance/uptake and determinants among this vulnerable population of PLHIV based on a systematic review and meta-analysis of studies published by 25 August 2023. Among the 54 included studies (N = 167,485 participants), 53 (N = 166,455) provided data on vaccine acceptance rate, while 27 (N = 150,926) provided uptake data. The global prevalences of COVID-19 vaccine acceptance and uptake were 67.0% and 56.6%, respectively. Acceptance and uptake rates were 86.6% and 90.1% for the European Region, 74.9% and 71.6% for the Region of the Americas, 62.3% and 78.9% for the South-East Asian Region, 64.6% and 19.3% for the Eastern Mediterranean Region, 58.0% and 35.5% for the African Region, and 57.4% and 44.0% for the Western Pacific Region. The acceptance rate increased from 65.9% in 2020 to 71.0% in 2022, and the uptake rate increased from 55.9% in 2021 to 58.1% in 2022. Men, PLHIV aged ≥40 years and those who had recently received the influenza vaccine were more likely to accept and receive the COVID-19 vaccine. Factors associated with lower uptake included Black race, other races (Latinx/Hispanic/mixed race), low education level and being unemployed. Vaccine-related factors associated with higher acceptance included belief in vaccine effectiveness, vaccine trust, perceived high susceptibility to SARS-CoV-2 infection and fear of potential COVID-19 effect in PLHIV. Sustained efforts and targeted interventions are needed to reduce regional disparities in COVID-19 vaccine uptake among PLHIV.

Mortality rate and predictors of COVID-19 inpatients in Ethiopia: a systematic review and meta-analysis

Introduction

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an extremely rare virus that devastates the economy and claims human lives. Despite countries' urgent and tenacious public health responses to the COVID-19 pandemic, the disease is killing a large number of people. The results of prior studies have not been used by policymakers and programmers due to the presence of conflicting results. As a result, this study was conducted to fill the knowledge gap and develop a research agenda.

Objective

This study aimed to assess the mortality rate and predictors of COVID-19 hospitalized patients in Ethiopia.

Methods

Electronic databases were searched to find articles that were conducted using a retrospective cohort study design and published in English up to 2022. The data were extracted using a Microsoft Excel spreadsheet and exported to StataTM version 17.0 for further analysis. The presence of heterogeneity was assessed and presented using a forest plot. The subgroup analysis, meta-regression, and publication bias were computed to identify the source of heterogeneity. The pool COVID-19 mortality rate and its predictors were calculated and identified using the random effects meta-analysis model, respectively. The significant predictors identified were reported using a relative risk ratio and 95% confidence interval (CI).

Results

Seven studies with 31,498 participants were included. The pooled mortality rate of COVID-19 was 9.13 (95% CI: 5.38, 12.88) per 1,000 person-days of mortality-free observation. Those study participants who had chronic kidney disease had 2.29 (95% CI: 1.14, 4.60) times higher chance of experiencing mortality than their corresponding counterparts, diabetics had 2.14 (95% CI: 1.22, 3.76), HIV patients had 2.98 (95% CI: 1.26, 7.03), hypertensive patients had 1.63 (95% CI: 1.43, 1.85), and smoker had 2.35 (95% CI: 1.48, 3.73).

Conclusion

COVID-19 mortality rate was high to tackle the epidemic of the disease in Ethiopia. COVID-19 patients with chronic renal disease, diabetes, hypertension, smoking, and HIV were the significant predictors of mortality among COVID-19 patients in Ethiopia. COVID-19 patients with chronic diseases and comorbidities need special attention, close follow-up, and care from all stakeholders.

Immunogenicity and effectiveness of COVID-19 booster vaccination among people living with HIV: a systematic review and meta-analysis

Background

The effect of booster vaccinations with the coronavirus virus disease (COVID-19) vaccine on people living with HIV (PLWH) remains unknown. In this study, we aimed to investigate the immunogenicity and effectiveness of booster doses of the COVID-19 vaccine in PLWH.

Methods

Literature research was done through the PubMed, Embase, Cochrane Review, and Web of Science databases up to 4 July 2023. Pooled estimates were calculated and compared using the DerSimonian and Laird method for a random effects model. Randomized control trials and observational studies were both considered for inclusion.

Results

We included 35 eligible studies covering 30,154 PLWH. The pooled immune response rate (IRR) of PLWH after the COVID-19 booster vaccination was 97.25% (95% confidence interval [CI], 93.81-99.49), and similar to healthy control (HC) (risk ratio [RR] = 0.98, 95% CI, 0.96-1.00). The pooled IRR for PLWH with CD4+ T-cell counts ≤ 200 was 86.27 (95% CI, 65.35-99.07). For Omicron variants, the pooled IRR for PLWH after booster dose was 74.07% (95% CI, 58.83-89.30), and the risk of IRR was reduced by 10% in PLWH compared with HC (RR = 0.90, 95% CI, 0.80-1.00). The T-cell immune response of PLWH was found to be comparable to HC (p ≥ 0.05). Subgroup analyses revealed that mRNA vaccines produced a relatively high IRR in PLWH compared to other vaccines. In addition, the results showed that booster vaccination appeared to further reduce the risk of COVID-19-related infections, hospitalizations, and deaths compared with the primary vaccination.

Conclusion

It was shown that booster vaccination with the COVID-19 vaccine provided a high IRR in PLWH and still produced a desirable moderate IRR in PLWH with a CD4+ T-cell count of ≤ 200. Importantly, the humoral and T-cell responses to booster vaccination in PLWH were comparable to HC, and similar results were observed with the SARS-CoV-2 Omicron variant. Our review strongly emphasizes the effect of mRNA vaccine booster vaccination in PLWH on eliciting desirable protective IRR. Furthermore, booster vaccination appears to further reduce the risk of COVID-19 infection, hospitalization, and death in PLWH compared to primary vaccination. However, more evidence is needed to confirm its effectiveness.

Substance use and other factors associated with COVID-19 vaccine uptake among people at risk for or living with HIV: Findings from the C3PNO consortium

Objective

We describe the prevalence of COVID-19 vaccine uptake, substance use, and other factors associated with vaccine hesitancy among participants from nine North American cohort studies following a diverse group of individuals at risk for or living with HIV.

Methods

Between May 2021 and January 2022, participants completed a survey related to COVID-19 vaccination. Participants included those with and without substance use. Those responding as 'no' or 'undecided' to the question "Do you plan on getting the COVID-19 vaccine?" were categorized as vaccine hesitant. Differences between groups were evaluated using chi-square methods and multivariable log-binomial models were used to calculate prevalence ratios (PR) of COVID-19 vaccine hesitancy with separate models for each substance.

Results

Among 1,696 participants, COVID-19 vaccination was deferred or declined by 16%. Vaccine hesitant participants were younger, with a greater proportion unstably housed (14.8% vs. 10.0%; p = 0.02), and not living with HIV (48.% vs. 36.6%; p <.01). Vaccine hesitant participants were also more likely to report cannabis (50.0% vs. 42.4%; p = 0.03), methamphetamine (14.0% vs. 8.2%; p <.01), or fentanyl use (5.5% vs. 2.8%; p = 0.03). Based on multivariable analyses methamphetamine or fentanyl use remained associated with COVID-19 vaccine hesitancy (Adjusted PR = 1.4; 95% CI 1.1-1.9 and Adjusted PR = 1.6; 95% CI 1.0-2.6, respectively).

Conclusion

As new COVID-19 vaccines and booster schedules become necessary, people who use drugs (PWUD) may remain vaccine hesitant. Strategies to engage hesitant populations such as PWUD will need to be tailored to include special types of outreach such as integration with substance use programs such as safe injection sites or recovery programs.

Risk of COVID-19 hospitalization in people living with HIV and HIV-negative individuals and the role of COVID-19 vaccination: A retrospective cohort study

OBJECTIVE

To examine the risk of hospitalization within 14 days of COVID-19 diagnosis among people living with HIV (PLWH) and HIV-negative individuals who had laboratory-confirmed SARS-CoV-2 infection.

METHODS

We used Cox proportional hazard models to compare the relative risk of hospitalization in PLWH and HIV-negative individuals. Then, we used propensity score weighting to examine the influence of sociodemographic factors and comorbid conditions on risk of hospitalization. These models were further stratified by vaccination status and pandemic period (pre-Omicron: December 15, 2020, to November 21, 2021; Omicron: November 22, 2021, to October 31, 2022).

RESULTS

The crude hazard ratio (HR) for risk of hospitalization in PLWH was 2.44 (95% confidence interval [CI]: 2.04-2.94). In propensity score-weighted models that included all covariates, the relative risk of hospitalization was substantially attenuated in the overall analyses (adjusted HR [aHR]: 1.03; 95% CI: 0.85-1.25), in vaccinated (aHR 1.00; 95% CI: 0.69-1.45), inadequately vaccinated (aHR: 1.04; 95% CI: 0.76-1.41) and unvaccinated individuals (aHR: 1.15; 95% CI: 0.84-1.56).

CONCLUSION

PLWH had about two times the risk of COVID-19 hospitalization than HIV-negative individuals in crude analyses which attenuated in propensity score-weighted models. This suggests that the risk differential can be explained by sociodemographic factors and history of comorbidity, underscoring the need to address social and comorbid vulnerabilities (e.g., injecting drugs) that were more prominent among PLWH.

Risk Factors for SARS-CoV-2 Infection and Severe Outcomes Among People With Human Immunodeficiency Virus: Cohort Study

Background

Studies on COVID-19 in people with HIV (PWH) have had limitations. Further investigations on risk factors and outcomes of SARS-CoV-2 infection among PWH are needed.

Methods

This retrospective cohort study leveraged the national OPTUM COVID-19 data set to investigate factors associated with SARS-CoV-2 positivity among PWH and risk factors for severe outcomes, including hospitalization, intensive care unit stays, and death. A subset analysis was conducted to examine HIV-specific variables. Multiple variable logistic regression was used to adjust for covariates.

Results

Of 43 173 PWH included in this study, 6472 had a positive SARS-CoV-2 result based on a polymerase chain reaction test or antigen test. For PWH with SARS-CoV-2 positivity, higher odds were found for those who were younger (18-49 years), Hispanic White, African American, from the US South, uninsured, and a noncurrent smoker and had a higher body mass index and higher Charlson Comorbidity Index. For PWH with severe outcomes, higher odds were identified for those who were SARS-CoV-2 positive, older, from the US South, receiving Medicaid/Medicare or uninsured, a current smoker, and underweight and had a higher Charlson Comorbidity Index. In a subset analysis including PWH with HIV care variables (n = 5098), those with unsuppressed HIV viral load, a low CD4 count, and no antiretroviral therapy had higher odds of severe outcomes.

Conclusions

This large US study found significant ethnic, racial, and geographic differences in SARS-CoV-2 infection among PWH. Chronic comorbidities, older age, lower body mass index, and smoking were associated with severe outcomes among PWH during the COVID-19 pandemic. SARS-CoV-2 infection was associated with severe outcomes, but once we adjusted for HIV care variables, SARS-CoV-2 was no longer significant; however, low CD4 count, high viral load, and lack of antiretroviral therapy had higher odds of severe outcomes.

COVID-19 and HIV: Clinical Outcomes among Hospitalized Patients in the United States

The concurrence of HIV and COVID-19 yields unique challenges and considerations for healthcare providers, patients living with HIV, and healthcare systems at-large. Persons living with HIV may face a higher risk of acquiring SARS-CoV-2 infection and experiencing worse clinical outcomes compared to those without. Notably, COVID-19 may have a disproportionate impact on historically disadvantaged populations, including African Americans and those stratified in a lower socio-economic status. Using the National Inpatient Sample (NIS) database, we compared patients with a diagnosis of both HIV and COVID-19 and those who exclusively had a diagnosis of COVID-19. The primary outcome was in-hospital mortality. Secondary outcomes were intubation rate and vasopressor use; acute MI, acute kidney injury (AKI); AKI requiring hemodialysis (HD); venous thromboembolism (VTE); septic shock and cardiac arrest; length of stay; financial burden on healthcare; and resource utilization. A total of 1,572,815 patients were included in this study; a COVID-19-positive sample that did not have HIV (n = 1,564,875, 99.4%) and another sample with HIV and COVID-19 (n = 7940, 0.56%). Patients with COVID-19 and HIV did not have a significant difference in mortality compared to COVID-19 alone (10.2% vs. 11.3%, respectively, p = 0.35); however, that patient cohort did have a significantly higher rate of AKI (33.6% vs. 28.6%, aOR: 1.26 [95% CI 1.13-1.41], p < 0.001). Given the complex interplay between HIV and COVID-19, more prospective studies investigating the factors such as the contribution of viral burden, CD4 cell count, and the details of patients' anti-retroviral therapeutic regimens should be pursued.

Expert Consensus: Main Risk Factors for Poor Prognosis in COVID-19 and the Implications for Targeted Measures against SARS-CoV-2

The clinical evolution of patients infected with the Severe Acute Respiratory Coronavirus type 2 (SARS-CoV-2) depends on the complex interplay between viral and host factors. The evolution to less aggressive but better-transmitted viral variants, and the presence of immune memory responses in a growing number of vaccinated and/or virus-exposed individuals, has caused the pandemic to slowly wane in virulence. However, there are still patients with risk factors or comorbidities that put them at risk of poor outcomes in the event of having the coronavirus infectious disease 2019 (COVID-19). Among the different treatment options for patients with COVID-19, virus-targeted measures include antiviral drugs or monoclonal antibodies that may be provided in the early days of infection. The present expert consensus is based on a review of all the literature published between 1 July 2021 and 15 February 2022 that was carried out to establish the characteristics of patients, in terms of presence of risk factors or comorbidities, that may make them candidates for receiving any of the virus-targeted measures available in order to prevent a fatal outcome, such as severe disease or death. A total of 119 studies were included from the review of the literature and 159 were from the additional independent review carried out by the panelists a posteriori. Conditions found related to strong recommendation of the use of virus-targeted measures in the first days of COVID-19 were age above 80 years, or above 65 years with another risk factor; antineoplastic chemotherapy or active malignancy; HIV infection with CD4+ cell counts < 200/mm³; and treatment with anti-CD20 immunosuppressive drugs. There is also a strong recommendation against using the studied interventions in HIV-infected patients with a CD4+ nadir <200/mm³ or treatment with other immunosuppressants. Indications of therapies against SARS-CoV-2, regardless of vaccination status or history of infection, may still exist for some populations, even after COVID-19 has been declared to no longer be a global health emergency by the WHO.

Biological mechanisms underpinning the development of long COVID

As COVID-19 evolves from a pandemic to an endemic disease, the already staggering number of people that have been or will be infected with SARS-CoV-2 is only destined to increase, and the majority of humanity will be infected. It is well understood that COVID-19, like many other viral infections, leaves a significant fraction of the infected with prolonged consequences. Continued high number of SARS-CoV-2 infections, viral evolution with escape from post-infection and vaccinal immunity, and reinfections heighten the potential impact of Long COVID. Hence, the impact of COVID-19 on human health will be seen for years to come until more effective vaccines and pharmaceutical treatments become available. To that effect, it is imperative that the mechanisms underlying the clinical manifestations of Long COVID be elucidated. In this article, we provide an in-depth analysis of the evidence on several potential mechanisms of Long COVID and discuss their relevance to its pathogenesis.

Seroprevalence of SARS-CoV-2 IgG and associated factors among people living with HIV over the first 12 months following the outbreak of COVID-19 in Burkina Faso, a sub-Saharan African country

OBJECTIVE

This study aimed to evaluate the seroprevalence of anti-SARS-CoV-2 IgG and factors associated with the infection among PLWHIV over the first 12 months following the outbreak of COVID-19 in Burkina Faso.

DESIGN

A retrospective cross-sectional study of plasma samples collected from March 9, 2020, and March 8, 2021, at the outpatient HIV referral center, before the introduction of the SARS-CoV-2 vaccine in Burkina Faso.

METHODS

Anti-SARS-CoV-2 IgG were detected in plasma using DS-ЕIA-ANTI-SARS-CoV-2-G (S) kit. Logistic regressions were used to compare SARS-CoV-2 specific immune responses between groups and within subgroups.

RESULTS AND DISCUSSION

A total of 419 plasma were subjected to serological diagnosis. None of the participants was vaccinated against COVID-19 during the period of sample collection, and 130 samples were positive for anti-SARS-CoV-2 IgG, giving a prevalence of 31.0% (95% CI 26.6-35.7). The median CD4 cell count was 661 cells/μL (IQR,422-928). Retailers had half the risk of being infected compared to housemaids with an OR of 0.49 (p = 0.028, 95% CI 0.26-0.91). Likewise, the risk of infection was 1.69 times higher in patients on integrase inhibitors compared to that of patients on non-nucleoside reverse transcriptase inhibitors (p = 0.020, 95% CI 1.09-2.63).

CONCLUSION

Our study reveals a high seroprevalence among PLWHIV to SARS-CoV-2 during the first year of the pandemic. In addition, PLWHIV on integrase inhibitors are 1.69 times more likely to be infected than PLWHIV on non-nucleoside inhibitors, and this observation remains an intriguing topic that still needs to be clarified.

Persistence of SARS-CoV-2 IgG Antibody Response among South African Adults: A Prospective Cohort Study

This study assesses the durability of severe acute respiratory coronavirus-2 (SARS-CoV-2) anti-nucleocapsid (anti-N) immunoglobulin G (IgG) after infection and examines its association with established risk factors among South African healthcare workers (HCWs). Blood samples were obtained from 390 HCWs with diagnosis of coronavirus disease 2019 (COVID-19) for assay of the SARS-CoV-2 anti-N IgG at two time points (Phase 1 and 2) between November 2020 and February 2021. Out of 390 HCWs with a COVID-19 diagnosis, 267 (68.5%) had detectable SARS-CoV-2 anti-N IgG antibodies at the end of Phase I. These antibodies persisted for 4-5 and 6-7 months in 76.4% and 16.1%, respectively. In the multivariate logistic regression model analysis, Black participants were more likely to sustain SARS-CoV-2 anti-N IgG for 4-5 months. However, participants who were HIV positive were less likely to sustain SARS-CoV-2 anti-N IgG antibodies for 4-5 months. In addition, individuals who were <45 years of age were more likely to sustain SARS-CoV-2 anti-N IgG for 6-7 months. Of the 202 HCWs selected for Phase 2, 116 participants (57.4%) had persistent SARS-CoV-2 anti-N IgG for an extended mean period of 223 days (7.5 months). Findings support the longevity of vaccine responses against SARS-CoV-2 in Black Africans.

COVID-19 Infection as an Exacerbated Factor of Oral Candidiasis in HIV/AIDS Patient

Introduction

Oral candidiasis is an oral mucosal infection caused by Candida sp. This infection can appear in patients with HIV/AIDS associated with immunodeficiency. Another factor that can aggravate the occurrence of oral candidiasis is the COVID-19 infection caused by the SARS-CoV-2 virus as a current pandemic condition. This case report aims to explain the mechanism of COVID-19 infection as a factor that can aggravate the condition of oral candidiasis in HIV/AIDS patients.

Case

A 56-year-old male patient was consulted from the COVID-19 isolation unit to the Department of Oral Medicine with complaints of sore and uncomfortable mouth related to white plaque covering the surface of the tongue. The patient was diagnosed with HIV/AIDS and had a COVID-19 infection. The management instructions were to maintain oral hygiene, administration of antifungal drugs such as nystatin oral suspension and fluconazole, chlorhexidine gluconate 0.2% mouthwash, and vaseline album.

Discussion

Generally, HIV/AIDS patient has dysregulation of the immune system which can suppress host immunity to fight pathogens, making it easy for opportunistic infections such as oral candidiasis. The COVID-19 infection can cause lymphopenia conditions that further reduce the host's ability to fight pathogens. The SARS-CoV-2 virus can also directly attack various tissues in the oral mucosa which can contribute to exacerbating the severity of oral candidiasis in HIV/AIDS patients.

Conclusion

The COVID-19 infection is a factor that can exacerbate the condition of oral candidiasis in HIV/AIDS patients by further decreasing the host's immunity and damaging various tissues in the oral mucosa.

A Systematic Review: Impact of SARS-CoV-2 Infection on Morbidity, Mortality, and Viral Suppression in Patients Living With HIV

People living with HIV (PLWH) are a vulnerable patient population due to their immunosuppressed state and the risks associated with interruptions in treatment. After the unprecedented start of the COVID-19 pandemic, PLWH experienced complications involving interruptions in care and treatment, potentially leading to adverse outcomes including reduced rates of viral suppression, increased hospitalizations, and death. A systematic, comprehensive literature search was completed using PubMed, Google Scholar, and bibliography review to identify relevant articles related to clinical outcomes of HIV and SARS-CoV-2 co-infection. Related keywords were used as search terms: "COVID", "SARS-CoV-2", "coronavirus", "HIV", "viral load", "viral suppression", and "disease severity". Of the 492 results, 7 systematic reviews and 14 individual studies were included in the current review of literature regarding COVID-19-related outcomes in PLWH. In total, 2 systematic reviews and 8 individual studies found an increased rate of mortality, hospitalizations, and/or severe COVID-19 outcomes in PLWH co-infected with SARS-CoV-2, whereas the other 5 systematic reviews and 6 individual studies concluded PLWH were not at an increased risk compared to patients without HIV. Regarding viral suppression, 4 of 5 studies found viral suppression in PLWH was not impacted by the COVID-19 pandemic. The current literature suggests that the morbidity and mortality associated with SARS-CoV-2 infection in PLWH is complex and involves multiple factors including age and comorbid conditions; however, there is no clear consensus thus far. In contrast, literature consistently demonstrates that viral suppression during the pandemic has remained unchanged, potentially due to increased implementation of telemedicine and multicomponent interventions deployed.

The effect of HIV on COVID-19 vaccine responses

PURPOSE OF REVIEW

Persons living with HIV (PLWH) may have a moderately increased risk of morbidity and mortality from COVID-19 infection, especially if viral load is not controlled and if they are immunosuppressed. Vaccination against SARS-CoV-2 is the most effective measure to prevent morbidity and mortality. However, individuals with HIV/AIDS may have less protection after vaccination. The purpose of this review is to summarize some of the recent studies focused on examining the safety, immunogenicity and effectiveness of anti-SARS-CoV-2 vaccines.

RECENT FINDINGS

The safety of all anti-SARS-CoV-2 vaccines among PLWH is not different from the safety of these vaccines among HIV-negative individuals and is acceptable. PLWH with viral suppression and immune reconstitution (CD4 + cell count > 350 cells/μl) may reach almost same immunogenicity such as people without HIV albeit antibody levels and neutralization may decline more rapidly than in people without HIV. PLWH with viremia or immunosuppressed, especially AIDS, have less immunogenicity.

SUMMARY

Full vaccination against SARS-CoV-2 is a well tolerated and efficient way to prevent mortality and morbidity from COVID-19 among PLWH and AIDS patients. It is very important to follow recommended booster vaccination for a continuous and prompt immunogenicity.

Double Trouble Co-Infections: Understanding the Correlation Between COVID-19 and HIV Viruses

A global outbreak of coronavirus disease 2019 (COVID-19), an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), mounted a substantial threat to public health worldwide. It initially emerged as a mere outbreak in Wuhan, China, in December 2019 and quickly engulfed the entire world, evolving into a global pandemic, consuming millions of lives and leaving a catastrophic effect on our lives in ways unimaginable. The entire healthcare system was significantly impacted and HIV healthcare was not spared. In this article, we reviewed the effect of HIV on COVID-19 disease and the ramifications of the recent COVID-19 pandemic over HIV management strategies. Our review highlights that contrary to the instinctive belief that HIV should render patients susceptible to COVID-19 infection, the studies depicted mixed results, although comorbidities and other confounders greatly affected the results. Few studies showed a higher rate of in-hospital mortality due to COVID-19 among HIV patients; however, the use of antiretroviral therapy had no consequential effect. COVID-19 vaccination was deemed safe among HIV patients in general. The recent pandemic can destabilize the HIV epidemic control as it hugely impacted access to care and preventive services and led to a marked reduction in HIV testing. The collision of these two disastrous pandemics warrants the need to materialize rigorous epidemiological measures and health policies, but most importantly, brisk research in prevention strategies to mitigate the combined burden of the two viruses and to battle similar future pandemics.

Consequences of COVID-19 Among Adult HIV Patients Versus Non-HIV Patients: Two-Year Data From the Primary Isolation Centre in Sudan

Background The COVID-19 pandemic remains to have a global impact despite the great efforts in prevention. Controversy persists regarding the outcomes of SARS-CoV-2 among HIV patients versus non-HIV individuals. Objective This study aimed to assess the impact of COVID-19 among adult patients with HIV versus non-HIV in the chief isolation centre in Khartoum state, Sudan. Methods This is an analytical cross-sectional, comparative single-centre study conducted at the Chief Sudanese Coronavirus Isolation Centre in Khartoum from March 2020 to July 2022. Data were analysed using SPSS V.26 (IBM Corp., Armonk, USA). Results This study included 99 participants. The overall age mean was 50±1 years old, with a male predominance of 66.7% (n=66). 9.1% (n=9) of the participants were HIV cases, 33.3% of whom were newly diagnosed. The majority, 77.8%, reported poor adherence to anti-retroviral therapy. The most common complications included acute respiratory failure (ARF) and multiple organ failure, 20.2% and 17.2%, respectively. The overall complications were higher among HIV cases than non-HIV cases; however, statistically insignificant (p>0.05 ), except for acute respiratory failure (p<0.05). 48.5% of participants were admitted to the intensive care unit (ICU), with slightly higher rates among HIV cases; however, this was statistically insignificant (p=0.656). Regarding the outcome, 36.4% (n=36) recovered and were discharged. Although a higher mortality rate was reported among HIV cases compared to non-HIV cases (55% vs 40%), it was statistically insignificant (p=0.238). Conclusion The mortality and morbidity percent proportion among HIV patients with superimposed COVID-19 infection was higher than in non-HIV patients but statistically insignificant aside from ARF. Consequently, this category of patients, to a large extent, should not be considered highly susceptible to adverse outcomes when infected with COVID-19; however, ARF should be closely monitored for.

COVID-19 Adverse Outcomes in Immunocompromised Patients

Background: Coronavirus disease 2019 (COVID-19) is a devastating viral pandemic infecting millions of people with a wide range of symptoms from fever to death. It has been suggested that immunocompromised patients are at a higher risk of severe disease, poor clinical outcomes, and mortality. However, these patients’ risk factors and COVID-19-related outcomes are not well characterized. Objectives: We evaluated the COVID-19-related outcomes among immunocompromised patients ranging from solid tumors, hematological malignancies, and HIV to autoimmune disease and transplant recipients who received immunosuppressive agents. We also aimed at finding risk factors related to mortality among immunocompromised patients with COVID-19. Methods: This cross-sectional study was conducted in Khansari Hospital, Iran between March and November 2021. We included immunocompromised patients with nasal swab positive SARS-CoV-2 polymerase chain reaction (PCR) results in the study. Patient outcomes, including hospitalization ward and the mortality rate, were assessed till three months after COVID-19 infection were evaluated in all patients. Moreover, the relation between risk factors and the rate of the mortality rate was analyzed in immunocompromised patients with COVID-19. Results: A total number of 74 immunocompromised patients with solid tumors, hematologic malignancies, autoimmune diseases, acquired immunodeficiencies, and solid-organ transplant recipients were included in the study. Results indicated that the male gender and ICU hospitalization significantly increase the mortality risk. Surprisingly, chemotherapy is associated with a lower risk of mortality. Conclusions: Identifying the risk factors can improve the decision-making on cancer patients’ management during the COVID-19 infection. A further large cohort of patients would be required to identify risk factors relating to poor clinical outcomes and mortality rates in immunocompromised patients with COVID-19.

HIV and chronic lung disease

PURPOSE OF REVIEW

As people living with human immunodeficiency virus (HIV, PLWH) age, aging-related comorbidities have come into focus as major challenges to their overall health. In this review, an in-depth overview of the two most commonly encountered chronic lung diseases in PLWH, chronic obstructive pulmonary disease (COPD) and lung cancer, is provided.

RECENT FINDINGS

The risk for both COPD and lung cancer remains significantly higher in PLWH compared to the HIV-uninfected population, although fortunately rates of lung cancer appear to be declining over the last two decades. Outcomes for PLWH with these conditions, though, continue to be poor with worse survival rates in comparison to the general population. PLWH still face major barriers in accessing care for these conditions, including a higher likelihood of being underdiagnosed with COPD and a lower likelihood of being referred for lung cancer screening or treatment. A lack of evidence for optimal treatment strategies for both COPD and lung cancer still hampers the care of PLWH with these conditions.

SUMMARY

COPD and lung cancer represent substantial burdens of disease in PLWH. Improved access to standard-of-care screening and treatment and greater investigation into therapeutic responses specifically in this population are recommended.

COVID-19 vaccine hesitancy among people living with HIV in a low-resource setting: A multi-center study of prevalence, correlates and reasons

BACKGROUND

Hesitancy to COVID-19 vaccine may worsen the burden of COVID-19 among people living with HIV (PLHIV), who are at a higher risk of COVID-19-related hospitalization and death, compared to HIV non-infected individuals. Therefore, we evaluate the predictors and reasons for COVID-19 vaccine hesitancy among unvaccinated PLHIV in six antiretroviral therapy (ART) clinics across northern Nigeria.

METHODOLOGY

In this cross-sectional study, conducted between October 2021 and February 2022 in six hospitals across two geopolitical regions of Nigeria, we utilized interviewer-administered questionnaires to assess COVID-19 vaccine hesitancy among a convenience sample of 790 eligible adult PLHIV. Hesitancy was defined as answering 'no' or 'maybe' to a question asking participants their willingness to accept the COVID-19 vaccine. A multivariate logistic regression model was used to estimate the adjusted odds ratio (aOR) and 95% confidence interval (CI) of the factors associated with COVID-19 vaccine hesitancy among PLHIV.

RESULTS

Of the total 660 unvaccinated participants included in the analysis (61.82% female, mean age [SD] of 39.76 [10.75]), 381 (57.72%) were hesitant to COVID-19 vaccine. Being 50 years and older (aOR: 0.43; 95% CI: 0.21-0.89), being unemployed (aOR: 0.57; 95% CI: 0.34-0.95), experiencing the adverse effects of ART (aOR: 0.36; 95% CI: 0.15-0.86), and perception of being at high risk of contracting COVID-19 (aOR: 0.22; 95% CI: 0.13-0.37) were associated with significantly lower odds of hesitancy. Conversely, being female (aOR: 1.64; 95% CI: 1.02-2.61) and attending ART clinics at state administrative capital cities (IIDH Kano [aOR: 2.40; 95% CI: 1.10-5.25], MMSH Kano [aOR: 5.59; 95% CI: 1.97-10.66], YSSH Damaturu [aOR: 9.88; 95% CI: 4.02-24.29] vs. GH Gashua) were associated with significantly higher odds of hesitancy. The most common reasons for hesitancy include fear of potential adverse effects, skepticism about vaccine efficacy, the rapid development of the COVID-19 vaccine, and the perceived lack of effort to develop a cure or vaccine for HIV/AIDS.

CONCLUSION

Interventions aimed at combating misperceptions and misinformation regarding the COVID-19 vaccination program may reduce the prevalence of COVID-19 vaccine hesitancy among unvaccinated PLHIV.

HIV and COVID-19 Co-Infection: Epidemiology, Clinical Characteristics, and Treatment

The COVID-19 pandemic has been a global medical emergency with a significant socio-economic impact. People with HIV (PWH), due to the underlying immunosuppression and the particularities of HIV stigma, are considered a vulnerable population at high risk. In this review, we report what is currently known in the available literature with regards to the clinical implications of the overlap of the two epidemics. PWH share the same risk factors for severe COVID-19 as the general population (age, comorbidities), but virological and immunological status also plays an important role. Clinical presentation does not differ significantly, but there are some opportunistic infections that can mimic or co-exist with COVID-19. PWH should be prime candidates for preventative COVID-19 treatments when they are available, but in the setting of resistant strains, this might be not easy. When considering small-molecule medications, physicians need to always remember to address potential interactions with ART, and when considering immunosuppressants, they need to be aware of potential risks for opportunistic infections. COVID-19 shares similarities with HIV in how the public perceives patients-with fear of the unknown and prejudice. There are opportunities for HIV treatment hidden in COVID-19 research with the leaps gained in both monoclonal antibody and vaccine development.

Predictors of in-hospital mortality in HIV-infected patients with COVID-19

BACKGROUND

Underlying immunodeficiency is associated with severe COVID-19, but the prognosis of persons with human immunodeficiency virus (HIV) (PWH) with COVID-19 is under debate. Aim: assessment of the mortality rate and major determinants of death in HIV-infected patients hospitalized with COVID-19 in Spain before vaccine availability. Design: Retrospective nationwide public database analysis.

METHODS

Nationwide, retrospective, observational analysis of all hospitalizations with COVID-19 during year 2020 in Spain. Stratification was made according to HIV status. The National Registry of Hospital Discharges was used with the ICD-10 coding list.

RESULTS

A total of 117 694 adults were hospitalized with COVID-19 during 2020. Only 234 (0.2%) were HIV-positives. More than 95% were on antiretroviral therapy. Compared to HIV-negatives, PWH were younger (mean age 53.2 vs. 66.5 years old; P<0.001) and more frequently male (74.8% vs. 56.6%; P<0.001). Most co-morbidities predisposing to severe COVID-19 (diabetes, hypertension, dementia and cardiovascular disease) were more frequent in HIV-negatives. In contrast, the rate of baseline liver disease was over 6-fold higher in PWH (27.4% vs. 4.4%; P<0.001). In-hospital mortality was lower in PWH (9.4% vs. 16%; P=0.004). In multivariate analysis, older age, dementia and especially advanced liver disease (relative risk (RR): 7.6) were the major determinants of death in PWH hospitalized with COVID-19.

CONCLUSION

HIV-infected patients hospitalized in Spain with COVID-19 during 2020 had better survival than HIV-negatives, most likely explained by younger age and lower rate of co-morbidities. However, advanced liver disease was a major predictor of death in PWH hospitalized with COVID-19.

A comparison of four epidemic waves of COVID-19 in Malawi; an observational cohort study

BACKGROUND

Compared to the abundance of clinical and genomic information available on patients hospitalised with COVID-19 disease from high-income countries, there is a paucity of data from low-income countries. Our aim was to explore the relationship between viral lineage and patient outcome.

METHODS

We enrolled a prospective observational cohort of adult patients hospitalised with PCR-confirmed COVID-19 disease between July 2020 and March 2022 from Blantyre, Malawi, covering four waves of SARS-CoV-2 infections. Clinical and diagnostic data were collected using an adapted ISARIC clinical characterization protocol for COVID-19. SARS-CoV-2 isolates were sequenced using the MinION™ in Blantyre.

RESULTS

We enrolled 314 patients, good quality sequencing data was available for 55 patients. The sequencing data showed that 8 of 11 participants recruited in wave one had B.1 infections, 6/6 in wave two had Beta, 25/26 in wave three had Delta and 11/12 in wave four had Omicron. Patients infected during the Delta and Omicron waves reported fewer underlying chronic conditions and a shorter time to presentation. Significantly fewer patients required oxygen (22.7% [17/75] vs. 58.6% [140/239], p < 0.001) and steroids (38.7% [29/75] vs. 70.3% [167/239], p < 0.001) in the Omicron wave compared with the other waves. Multivariable logistic-regression demonstrated a trend toward increased mortality in the Delta wave (OR 4.99 [95% CI 1.0-25.0 p = 0.05) compared to the first wave of infection.

CONCLUSIONS

Our data show that each wave of patients hospitalised with SARS-CoV-2 was infected with a distinct viral variant. The clinical data suggests that patients with severe COVID-19 disease were more likely to die during the Delta wave.

SARS-CoV-2-specific T cell and humoral immunity in individuals with and without HIV in an African population: a prospective cohort study

OBJECTIVES

To longitudinally compare SARS-CoV-2-specific T cell and humoral immune responses between convalescent individuals who are HIV-positive (HIV+) and HIV-negative (HIV-).

METHODS

We conducted enzyme-linked immunospots to determine the SARS-CoV-2-specific T cell responses to spike and nucleocapsid, membrane protein, and other open reading frame proteins (NMO), whereas an immunofluorescence assay was used to determine the humoral responses. Participants were sampled at baseline and after 8 weeks of follow-up.

RESULTS

Individuals who are HIV- had significantly more T cell responses to NMO and spike than individuals who are HIV+ at baseline, P-value = 0.026 and P-value = 0.029, respectively. At follow-up, T cell responses to NMO and spike in individuals who are HIV+ increased to levels comparable with individuals who are HIV-. T cell responses in the HIV- group significantly decreased from baseline levels at the time of follow-up (spike [P-value = 0.011] and NMO [P-value = 0.014]). A significantly higher number of individuals in the HIV+ group had an increase in T cell responses to spike (P-value = 0.01) and NMO (P-value = 0.026) during the follow-up period than the HIV- group. Antispike and antinucleocapsid antibody titers were high (1: 1280) and not significantly different between individuals who were HIV- and HIV+ at baseline. A significant decrease in antinucleocapsid titer was observed in the HIV- (P-value = 0.0001) and the HIV+ (P-value = 0.001) groups at follow-up. SARS-CoV-2 vaccination was more effective in boosting the T cell than antibody responses shortly after infection.

CONCLUSION

There is an impairment of SARS-CoV-2-specific T cell immunity in individuals who are HIV+ with advanced immunosuppression. SARS-CoV-2-specific T cell immune responses may be delayed in individuals who are HIV+, even in those on antiretroviral therapy. There is no difference in SARS-CoV-2-specific humoral immunity between individuals who are HIV- and HIV+.

HIV and COVID-19 Disease

Despite effective antiretroviral therapy (ART), HIV infected individuals throughout the world remain at significant risk of respiratory infections and non-communicable disease. Severe disease from SARS-CoV-2 is associated with a hyperinflammatory phenotype which manifests in the lungs as pneumonia and in some cases can lead to acute respiratory failure. Progression to severe COVID-19 is associated with comorbid disease such as obesity, diabetes mellitus and cardiovascular disease, however data concerning the associated risks of HIV coinfection are still conflicting, with large population studies demonstrating poorer outcomes, whilst smaller, case-controlled studies showing better outcomes. Furthermore, underlying immunopathological processes within the lungs and elsewhere, including interactions with other opportunistic infections (OI), remain largely undefined. Nonetheless, new and repurposed anti-viral therapies and vaccines which have been developed are safe to use in this population, and anti-inflammatory agents are recommended with the caveat that the coexistence of opportunistic infections is considered and excluded. Finally, HIV infected patients remain reliant on good ART adherence practices to maintain HIV viral suppression, and some of these practices were disrupted during the COVID-19 pandemic, putting these patients at further risk for acute and long-term adverse outcomes.

Outcomes following severe acute respiratory syndrome coronavirus 2 infection among individuals with and without HIV in Denmark

OBJECTIVE

To compare the risk of a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test and coronavirus disease 2019 (COVID-19) outcomes in people with HIV (PWH) with the general population, and estimate the association with vaccination status.

DESIGN

A nationwide, population based, matched cohort study.

METHODS

We included all Danish PWH ≥18 years ( n  = 5276) and an age and sex-matched general population cohort ( n  = 42 308). We used Cox regression analyses to calculate (adjusted) incidence rate ratios [(a)IRR] and further stratified and restricted the analyses.

RESULTS

We observed no major difference in risk of first positive SARS-CoV-2 test [aIRR: 0.8 (95% confidence interval (CI): 0.8-0.9)], but a higher risk of first hospital contact with COVID-19 and hospitalization with severe COVID-19 for PWH vs. controls [IRR: 2.0; (1.6-2.5), 1.8 (1.4-2.3)]. Risk of first hospitalization decreased substantially in PWH with calendar time [first half of year 2022 vs. 2020 IRR: 0.3; (0.2-0.6)], whereas the risk compared to population controls remained almost twofold increased. We did not observe increased risk of death after SARS-CoV-2 infection [aIRR: 0.7 (95% CI: 0.3-2.0)]. Compared to PWH who had received two vaccines PWH who receiving a third vaccine had reduced risk of first positive SARS-CoV-2 test, death (individuals ≥60years) and hospitalization [aIRR: 0.9 (0.7-1.0); 0.2 (0.1-0.7); 0.6 (0.2-1.2)].

CONCLUSION

PWH have almost the same risk of a positive SARS-CoV-2 test as the general population. Although risk of hospital contacts and severe outcomes following SARS-CoV-2 infection is increased, the risk of death does not seem to be substantially increased. Importantly, a third vaccine is associated with reduced risk of infection, and death.

Predicting Intention to Receive COVID-19 Vaccination in People Living with HIV using an Integrated Behavior Model

People living with HIV (PLHIV) are considered a high-risk population for developing a severe form of COVID-19. Vaccination is still one of the most important modalities in combating the disease due to the lack of an effective treatment. This multicenter study was performed from September to December 2021 with the aim to analyze the intention of PLHIV to receive the COVID-19 vaccination based on an integrated behavior model (IBM) in Indonesia. Of a total of 470 participants, 75.6% of patients were intent to be vaccinated. The model that was designed in this study explains 43.4% of the variance in intention to be vaccinated against COVID-19 in PLHIV (adjusted R2 = 0.434). Furthermore, the determinants used included instrumental attitude (β = 0.127, p < 0.05), subjective norm (β = 0.497, p < 0.01), and perceived behavioral control (β = 0.116, p < 0.01). This study concluded that an IBM could predict the intention of PLHIV to receive COVID-19 vaccination.

Risk Factors of Severe COVID-19: A Review of Host, Viral and Environmental Factors

The clinical course and outcome of COVID-19 are highly variable, ranging from asymptomatic infections to severe disease and death. Understanding the risk factors of severe COVID-19 is relevant both in the clinical setting and at the epidemiological level. Here, we provide an overview of host, viral and environmental factors that have been shown or (in some cases) hypothesized to be associated with severe clinical outcomes. The factors considered in detail include the age and frailty, genetic polymorphisms, biological sex (and pregnancy), co- and superinfections, non-communicable comorbidities, immunological history, microbiota, and lifestyle of the patient; viral genetic variation and infecting dose; socioeconomic factors; and air pollution. For each category, we compile (sometimes conflicting) evidence for the association of the factor with COVID-19 outcomes (including the strength of the effect) and outline possible action mechanisms. We also discuss the complex interactions between the various risk factors.

Factors Associated with Fatal COVID-19 Outcomes among People Living with HIV: A Cohort Study

BACKGROUND

People living with HIV (PLHIV) are at increased risk of COVID-19 death. However, information about whether factors related to the HIV-infection influence the COVID-19 outcome still remains conflicting.

OBJECTIVE

Here, we evaluate the risk factors for fatal COVID-19 in a cohort of PLHIV from the Moscow region, aged >18 years and diagnosed with COVID-19 between March 2020 and December 2021.

METHODS

Demographic, clinical and laboratory data were compared between different COVID-19 outcomes. To analyze the risk factors associated with COVID-19 death, we employed the logistic regression method. A total of 566 PLHIV were included in the analysis.

RESULTS

The majority of individuals, 338 (59.7%), were male; 194 (34.3%) were on antiretroviral therapy; 296 (52.3%) had a comorbidity; 174 (30.7%) of patients had drug and/or alcohol dependence; 160 (33.1%) patients had CD4 counts <200 cells/μl; 253 (51.9%) had undetectable viral load. Our analysis revealed that PLHIV >55 years old (OR, 12.88 [95% CI, 2.32-71.62]), patients with a viral load of more than 1000 copies/ml (OR, 2.45 [95%CI, 1.01-5.98]) and with CD4 counts <200 cell/μl (OR, 2.54 [95%CI, 1.02-6.28]), as well as with a history of cachexia (OR, 3.62 [95%CI, 1.26-10.39]) and pneumocystis pneumonia (OR, 2.47 [95%CI, 1.03-5.92]), and drug/alcohol dependence (OR, 2.70 [95%CI, 1.36-5.39]) were significantly more likely to die from COVID-19.

CONCLUSION

These data show that people with advanced HIV-1 infection have an increased risk of fatal COVID-19 outcomes and that there is a need to improve this population's access to health services and, hence, increase their survival rates.