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Nguyen VT, Nagavedu K, Morrison M, Chen T, Randall LM, Landazabal C, John B, Klompas M, Cocoros NM. COVID-19 Severity in People With HIV Compared With Those Without HIV. J Acquir Immune Defic Syndr 2024; 95:479-485. [PMID: 38301641 DOI: 10.1097/qai.0000000000003378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/11/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND People with HIV (PWH) may be at risk for more severe COVID-19 outcomes. We compared risk for severe COVID-19 in PWH with matched individuals without HIV. METHODS We identified adults in Massachusetts with a positive SARS-CoV-2 test, March 2020-July 2022, using electronic medical record data from 3 large clinical practice groups. We then used regression models to compare outcomes among PWH versus propensity score-matched people without HIV (matched 20:1) for severe COVID-19 (pneumonia or acute respiratory distress syndrome), hospitalization, and hospital length of stay. RESULTS We identified 171,058 individuals with COVID-19; among them, 768 PWH were matched to 15,360 individuals without HIV. Overall, severe COVID-19 and hospitalization were similar in PWH and those without HIV (severe COVID-19: 3.8% vs 3.0%, adjusted odds ratio [OR] 1.27, 95% confidence interval [CI]: 0.86-1.87; hospitalization: 12.1% vs 11.3%, adjusted OR: 1.08, 95% CI: 0.87 to 1.35). Compared with people without HIV, PWH with low CD4 T-cell counts (<200 cells/mm 3 ) had more severe COVID-19 (adjusted OR: 3.99, 95% CI: 2.06 to 7.74) and hospitalization (adjusted OR: 2.26, 95% CI: 1.35 to 3.80), but PWH with high CD4 counts had lower odds of hospitalization (adjusted OR: 0.73, 95% CI: 0.52 to 1.03). CONCLUSIONS PWH with low CD4 T-cell counts had worse COVID-19 outcomes compared with people without HIV, but outcomes for those with high CD4 counts were similar to, or better than, those without HIV. It is unclear whether these findings are generalizable to settings where PWH have less access to and engagement with health care.
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Affiliation(s)
- Vu-Thuy Nguyen
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA
| | - Kshema Nagavedu
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA
| | - Monica Morrison
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA
| | - Tom Chen
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA
- Harvard Medical School, Boston, MA; and
| | - Liisa M Randall
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA
| | - Claudia Landazabal
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA
| | - Betsey John
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA
| | - Michael Klompas
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA
- Harvard Medical School, Boston, MA; and
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Noelle M Cocoros
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA
- Harvard Medical School, Boston, MA; and
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Oprea C, Quirke S, Ianache I, Bursa D, Antoniak S, Bogdanic N, Vassilenko AI, Aimla K, Matulionyte R, Rukhadze N, Harxhi A, Fleischhans L, Lakatos B, Sedlacek D, Dragovic G, Verhaz A, Yancheva N, Acet O, Protopapas K, Kowalska JD. HIV disease metrics and COVID-19 infection severity and outcomes in people living with HIV in central and eastern Europe. HIV Med 2024; 25:343-352. [PMID: 38014768 DOI: 10.1111/hiv.13578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/27/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND To date there remains much ambiguity in the literature regarding the immunological interplay between SARS-CoV-2 and HIV and the true risk posed to coinfected individuals. There has been little conclusive data regarding the use of CD4 cell count and HIV viral load stratification as predictors of COVID-19 severity in this cohort. METHODS We performed a retrospective, observational cohort study on people living with HIV (PLWH) who contracted COVID-19 in central and eastern Europe. We enrolled 536 patients from 16 countries using an online survey. We evaluated patient demographics, HIV characteristics and COVID-19 presentation and outcomes. Statistical analysis was performed using SPSS 20.1. RESULTS The majority of the study cohort were male (76.4%) and 152 (28.3%) had a significant medical comorbidity. Median CD4 cell count at COVID-19 diagnosis was 605 cells/μL [interquartile range (IQR) 409-824]. The majority of patients on antiretroviral therapy (ART) were virally suppressed (92%). In univariate analysis, CD4 cell count <350 cells/μL was associated with higher rates of hospitalization (p < 0.0001) and respiratory failure (p < 0.0001). Univariate and multivariate analyses found that an undetectable HIV VL was associated with a lower rate of hospitalization (p < 0.0001), respiratory failure (p < 0.0001), ICU admission or death (p < 0.0001), and with a higher chance of full recovery (p < 0.0001). CONCLUSION We can conclude that detectable HIV viral load was an independent risk factor for severe COVID-19 illness and can be used as a prognostic indicator in this cohort.
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Affiliation(s)
- Cristiana Oprea
- Victor Babes Clinical Hospital for Infectious and Tropical Diseases, Bucharest, Romania
- Carol Davila University for Medicine and Pharmacy, Bucharest, Romania
| | - Siobhan Quirke
- Department of Medicine, Galway University Hospital, Galway, Ireland
| | - Irina Ianache
- Victor Babes Clinical Hospital for Infectious and Tropical Diseases, Bucharest, Romania
- Carol Davila University for Medicine and Pharmacy, Bucharest, Romania
| | - Dominik Bursa
- Department of Adults' Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Sergii Antoniak
- Viral Hepatitis and AIDS Department, Gromashevsky Institute of Epidemiology and Infectious Diseases, Kyiv, Ukraine
| | - Nikolina Bogdanic
- University Hospital for Infectious Diseases, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Anne I Vassilenko
- Global Fund Grant Management Department, Republican Scientific and Practical Center for Medical Technologies, Minsk, Belarus
| | | | - Raimonda Matulionyte
- Vilnius University, Faculty of Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Nino Rukhadze
- Infectious Diseases, AIDS and Clinical Immunology Center, Tbilisi, Georgia
| | - Arjan Harxhi
- University Hospital Center of Tirana, Infectious Disease Service, Tirana, Albania
| | - Lukáš Fleischhans
- Department of Infectious Diseases, 1st Faculty of Medicine, Charles University in Prague and Faculty Hospital Bulovka Hospital, Prague, Czech Republic
| | - Botond Lakatos
- National Institute of Hematology and Infectious Diseases, South-Pest Central Hospital, National Center of HIV, Budapest, Hungary
| | - Dalibor Sedlacek
- Charles University, Faculty of Medicine in Plzeň, University Hospital Plzeň, Plzen, Czech Republic
| | - Gordana Dragovic
- Faculty of Medicine, University of Belgrade, Department of Pharmacology, Clinical Pharmacology and Toxicology, Belgrade, Serbia
| | - Antonija Verhaz
- Department for Infectious Diseases, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Nina Yancheva
- Department for AIDS, Specialized Hospital for Active Treatment of Infectious and Parasitic Disease Sofia, Sofi, Bulgaria
| | - Oguzhan Acet
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Konstantinos Protopapas
- University General Hospital Attikon, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Al-Mozaini M, Al-Rahabani T, Dirar Q, Alashgar T, Rabaan AA, Murad W, Alotaibi J, Alrajhi A. Human immunodeficiency virus in Saudi Arabia: Current and future challenges. J Infect Public Health 2023; 16:1500-1509. [PMID: 37353430 DOI: 10.1016/j.jiph.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 05/23/2023] [Accepted: 06/11/2023] [Indexed: 06/25/2023] Open
Abstract
INTRODUCTION Understanding the pathophysiology of HIV infection has been crucial to the design of effective anti-viral strategies. HIV infection is declining worldwide due to early diagnosis and the effective long-term use of anti-retroviral therapy. New infections decreased from 3.3 million in 2002-2.3 million in 2012. However, in the Middle East and North Africa (MENA), an estimated 83,000 individuals still acquired the virus, with 37,000 morbidities reported. The first incidence of acquired immunodeficiency syndrome (AIDS) from the Kingdom of Saudi Arabia (KSA) was reported in 1984. By the end of 2013, around 1509 patients had been diagnosed with HIV infection. HIV surveillance has improved in KSA with advances in medical care, counseling, family planning, diagnostic evaluation, and anti-retroviral therapy, but challenges remain. Patients receiving anti-retroviral therapy still show significant morbidity and mortality. Further targeted treatment regimens and preventive strategies are required to control HIV infection in KSA. Progress towards meeting the 90-90-90 goals for HIV in the MENA has also not been systematically monitored. METHOD In this review, we examine current screening programs, therapeutic modalities, the emergence of drug resistance, and future perspectives for HIV-associated health care in KSA. CONCLUSION The aim is to offer insight for healthcare policymakers to comply with the UNAIDS 2020 vision program and help establish the prevailing paradigms in the HIV community for an AIDS-free generation and the 90-90-90 goals for diagnosis.
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Affiliation(s)
- Maha Al-Mozaini
- Immunocompromised Host Research Section, Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
| | | | - Qais Dirar
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Tala Alashgar
- Immunocompromised Host Research Section, Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ali A Rabaan
- Molecular Diagnostic Laboratory, JohnsHopkins Aramco Healthcare, Dahran, Saudi Arabia
| | - Waleed Murad
- Immunocompromised Host Research Section, Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Jawaher Alotaibi
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdulrahman Alrajhi
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Acharya A, Ambikan AT, Thurman M, Malik MR, Dyavar SR, Végvári Á, Neogi U, Byrareddy SN. Proteomic landscape of astrocytes and pericytes infected with HIV/SARS-CoV-2 mono/co-infection, impacting on neurological complications. RESEARCH SQUARE 2023:rs.3.rs-3031591. [PMID: 37398206 PMCID: PMC10312942 DOI: 10.21203/rs.3.rs-3031591/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Background Although most individuals recover from coronavirus disease 2019 (COVID-19) within a few weeks, some people continue to experience a wide range of symptoms known as post-acute sequelae of SARS-CoV-2 (PASC) or long COVID. Majority of patients with PASC develop neurological disorders like brain fog, fatigue, mood swings, sleep disorders, loss of smell and test among others collectively called neuro-PASC. While the people living with HIV (PWH) do not have a higher risk of developing severe disease and mortality/morbidity due to COVID-19. As a large section of PWH suffered from HIV-associated neurocognitive disorders (HAND), it is essential to understand the impact of neuro-PASC on people with HAND. In pursuit of this, we infected HIV/SARS-CoV-2 alone or together in primary human astrocytes and pericytes and performed proteomics to understand the impact of co-infection in the central nervous system. Methods Primary human astrocytes and pericytes were infected with SARS-CoV-2 or HIV or HIV + SARS-CoV-2. The concentration of HIV and SARS-CoV-2 genomic RNA in the culture supernatant was quantified using reverse transcriptase quantitative real time polymerase chain reaction (RT-qPCR). This was followed by a quantitative proteomics analysis of mock, HIV, SARS-CoV-2, and HIV + SARS-CoV-2 infected astrocytes and pericytes to understand the impact of the virus in CNS cell types. Results Both healthy and HIV-infected astrocytes and pericytes support abortive/low level of SARS-CoV-2 replication. In both mono-infected and co-infected cells, we observe a modest increase in the expression of SARS-CoV-2 host cell entry factors (ACE2, TMPRSS2, NRP1, and TRIM28) and inflammatory mediators (IL-6, TNF-α, IL-1β and IL-18). Quantitative proteomic analysis has identified uniquely regulated pathways in mock vs SARS-CoV-2, mock vs HIV + SARS-CoV-2, and HIV vs HIV + SARS-CoV-2 infected astrocytes and pericytes. The gene set enrichment analysis revealed that the top ten enriched pathways are linked to several neurodegenerative disorders, including Alzheimer's disease, Parkinson's disease, Huntington's disease, and amyotrophic lateral sclerosis. Conclusions Our study emphasizes the significance of long-term monitoring of patients co-infected with HIV and SARS-CoV-2 to detect and understand the development of neurological abnormalities. By unraveling the molecular mechanisms involved, we can identify potential targets for future therapeutic interventions.
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Hanson HA, Kim E, Badowski ME. A Systematic Review: Impact of SARS-CoV-2 Infection on Morbidity, Mortality, and Viral Suppression in Patients Living With HIV. SN COMPREHENSIVE CLINICAL MEDICINE 2023; 5:144. [PMID: 37214621 PMCID: PMC10183680 DOI: 10.1007/s42399-023-01480-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 05/24/2023]
Abstract
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.
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Affiliation(s)
- Hali A. Hanson
- University of Illinois at Chicago College of Pharmacy, Chicago, IL USA
- University of Illinois Hospital and Health Sciences System, Chicago, IL USA
| | - Eunice Kim
- University of Illinois at Chicago College of Pharmacy, Chicago, IL USA
| | - Melissa E. Badowski
- University of Illinois at Chicago College of Pharmacy, Chicago, IL USA
- University of Illinois Hospital and Health Sciences System, Chicago, IL USA
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Abbasi SAA, Noor T, Mylavarapu M, Sahotra M, Bashir HA, Bhat RR, Jindal U, Amin U, V A, Siddiqui HF. Double Trouble Co-Infections: Understanding the Correlation Between COVID-19 and HIV Viruses. Cureus 2023; 15:e38678. [PMID: 37288215 PMCID: PMC10243673 DOI: 10.7759/cureus.38678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2023] [Indexed: 06/09/2023] Open
Abstract
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.
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Affiliation(s)
| | - Tarika Noor
- Department of Medicine, Government Medical College, Patiala, Ludhiana, IND
| | | | - Monika Sahotra
- Department of Medicine, Bukovinian State Medical University, Chernivtsi, UKR
| | - Hunmble A Bashir
- Forensic Medicine, Combined Military Hospital (CMH) Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Rakshita Ramesh Bhat
- Medical Oncology, Mangalore Institute of Oncology, Mangalore, IND
- Internal Medicine, Bangalore Medical College and Research Institute, Bangalore, IND
| | - Urmi Jindal
- Department of Medicine, Karamshi Jethabhai Somaiya Medical College, Mumbai, IND
| | - Uzma Amin
- Pathology, Rawalpindi Medical University, Rawalpindi, PAK
| | - Anushree V
- Department of Medicine, Jagadguru Jayadeva Murugarajendra (JJM) Medical College, Davangere, IND
| | - Humza F Siddiqui
- Department of Medicine, Jinnah Sindh Medical University, Karachi, PAK
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7
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Monteiro MA, Prates GS, de Lima Nascimento NA, Veiga APR, Magri MMC, Polis TJB, Gascon MRP, Ferreira MD, Tiberto L, Pereira LO, Alves W, Fonseca LAM, Duarte AJS, Casseb J. SARS-CoV-2/COVID-19: Clinical Course Among Subjects HIV-1-Infected in Sao Paulo. Curr HIV Res 2022; 20:457-462. [PMID: 35748552 DOI: 10.2174/1570162x20666220624100248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/18/2022] [Accepted: 05/05/2022] [Indexed: 01/27/2023]
Abstract
INTRODUCTION People living with Human Immunodeficiency Virus (HIV) are under risk for co-infection with SARS-CoV-2. This population may be more prone to complications from COVID-19 due to persistent inflammation caused by HIV and higher incidence of metabolic syndromes, cardiovascular diseases, and malignancies, as well as being considered elderly at 50 years of age. The objective of this study was to report SARS-CoV-2 infection frequency, clinical evolution, and mortality in HIV-positive patients on antiretroviral therapy. METHODS The period of inquiry ranged from January to September 2020. Due to the social distance and the suspension of in-person medical care during the time of the investigation, we sent electronic questions about demographic, epidemiological, and clinical data to 403 HIV-infected patients. RESULTS Among 260 patients who answered the questionnaire, thirty-nine patients (15%) had suggestive symptoms and were tested for SARS-CoV-2 infection. Of this, 11 had positive results (32.4%) and no patient died of COVID-19 complications. Nine were male (3.4%), and the mean age of the patients with positive results was 43.2 years (± 9.6). 107 patients (41.1%) were over 50 years of age and their mean T-CD4+ cell count was 768. Eleven patients (4.2%) had a detectable HIV RNA viral load and 127 (48.8%) had comorbidities. These variables were not associated with an increased risk for infection. CONCLUSION The frequency of SARS-COV2 infection among HIV-infected is similar to the general population, and the clinical course is associated with the presence of comorbidities and not due to the HIV infection. However, new studies should be done to assess if this vulnerable population could answer the vaccine anti-SARS-Cov2.
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Affiliation(s)
- Mariana A Monteiro
- Departamento de Dermatologia do Hospital das Clínicas da Universidade de São Paulo, Ambulatório de Imunodeficiência Secundária (ADEE3002), São Paulo, Brazil
| | - Gabriela S Prates
- Departamento de Dermatologia do Hospital das Clínicas da Universidade de São Paulo, Ambulatório de Imunodeficiência Secundária (ADEE3002), São Paulo, Brazil
| | - Najara A de Lima Nascimento
- Departamento de Dermatologia do Hospital das Clínicas da Universidade de São Paulo, Ambulatório de Imunodeficiência Secundária (ADEE3002), São Paulo, Brazil
| | - Ana Paula R Veiga
- Departamento de Dermatologia do Hospital das Clínicas da Universidade de São Paulo, Ambulatório de Imunodeficiência Secundária (ADEE3002), São Paulo, Brazil
| | - Marcello M C Magri
- Departamento de Dermatologia do Hospital das Clínicas da Universidade de São Paulo, Ambulatório de Imunodeficiência Secundária (ADEE3002), São Paulo, Brazil
| | - Thales J B Polis
- Departamento de Dermatologia do Hospital das Clínicas da Universidade de São Paulo, Ambulatório de Imunodeficiência Secundária (ADEE3002), São Paulo, Brazil
| | - Maria R P Gascon
- Departamento de Dermatologia do Hospital das Clínicas da Universidade de São Paulo, Ambulatório de Imunodeficiência Secundária (ADEE3002), São Paulo, Brazil
| | - Mauricio D Ferreira
- Departamento de Dermatologia do Hospital das Clínicas da Universidade de São Paulo, Ambulatório de Imunodeficiência Secundária (ADEE3002), São Paulo, Brazil
| | - Larissa Tiberto
- Departamento de Dermatologia do Hospital das Clínicas da Universidade de São Paulo, Ambulatório de Imunodeficiência Secundária (ADEE3002), São Paulo, Brazil
| | - Luisa O Pereira
- Departamento de Dermatologia do Hospital das Clínicas da Universidade de São Paulo, Ambulatório de Imunodeficiência Secundária (ADEE3002), São Paulo, Brazil
| | - Wagner Alves
- Departamento de Dermatologia do Hospital das Clínicas da Universidade de São Paulo, Ambulatório de Imunodeficiência Secundária (ADEE3002), São Paulo, Brazil
| | - Luiz A M Fonseca
- Departamento de Dermatologia do Hospital das Clínicas da Universidade de São Paulo, Ambulatório de Imunodeficiência Secundária (ADEE3002), São Paulo, Brazil
| | - Alberto J S Duarte
- Departamento de Dermatologia do Hospital das Clínicas da Universidade de São Paulo, Ambulatório de Imunodeficiência Secundária (ADEE3002), São Paulo, Brazil
| | - Jorge Casseb
- Departamento de Dermatologia do Hospital das Clínicas da Universidade de São Paulo, Ambulatório de Imunodeficiência Secundária (ADEE3002), São Paulo, Brazil
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Seyedjavadi SS, Bagheri P, Nasiri MJ, Razzaghi-Abyaneh M, Goudarzi M. Fungal Infection in Co-infected Patients With COVID-19: An Overview of Case Reports/Case Series and Systematic Review. Front Microbiol 2022; 13:888452. [PMID: 35875562 PMCID: PMC9298665 DOI: 10.3389/fmicb.2022.888452] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/03/2022] [Indexed: 01/08/2023] Open
Abstract
Fungal co-infections are frequent in patients with coronavirus disease 2019 (COVID-19) and can affect patient outcomes and hamper therapeutic efforts. Nonetheless, few studies have investigated fungal co-infections in this population. This study was performed to assess the rate of fungal co-infection in patients with COVID-19 as a systematic review. EMBASE, MEDLINE, and Web of Science were searched considering broad-based search criteria associated with COVID-19 and fungal co-infection. We included case reports and case series studies, published in the English language from January 1, 2020 to November 30, 2021, that reported clinical features, diagnosis, and outcomes of fungal co-infection in patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Totally, 54 case reports and 17 case series were identified, and 181 patients (132 men, 47 women, and 2 not mentioned) co-infected with COVID-19 and fungal infection enrolled. The frequency of fungal co-infection among patients with COVID-19 was 49.7, 23.2, 19.8, 6.6, and 0.5% in Asia, America, Europe, Africa, and Australia, respectively. Diabetes (59.6%) and hypertension (35.9%) were found as the most considered comorbidities in COVID-19 patients with fungal infections. These patients mainly suffered from fever (40.8%), cough (30.3%), and dyspnea (23.7%). The most frequent findings in the laboratory results of patients and increase in C-reactive protein (CRP) (33.1%) and ferritin (18.2%), and lymphopenia (16%) were reported. The most common etiological agents of fungal infections were Aspergillus spp., Mucor spp., Rhizopus spp., and Candida spp. reported in study patients. The mortality rate was 54.6%, and the rate of discharged patients was 45.3%. Remdesivir and voriconazole were the most commonly used antiviral and antifungal agents for the treatment of patients. The global prevalence of COVID-19-related deaths is 6.6%. Our results showed that 54.6% of COVID-19 patients with fungal co-infections died. Thus, this study indicated that fungal co-infection and COVID-19 could increase mortality. Targeted policies should be considered to address this raised risk in the current pandemic. In addition, fungal infections are sometimes diagnosed late in patients with COVID-19, and the severity of the disease worsens, especially in patients with underlying conditions. Therefore, patients with fungal infections should be screened regularly during the COVID-19 pandemic to prevent the spread of the COVID-19 patients with fungal co-infection.
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Affiliation(s)
| | - Parmida Bagheri
- Department of Biotechnology, Faculty of Life Sciences and Biotechnology, Shahid Beheshti University, Tehran, Iran
| | - Mohammad Javad Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mehdi Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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9
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Napuri NI, Curcio D, Swerdlow DL, Srivastava A. Immune Response to COVID-19 and mRNA Vaccination in Immunocompromised Individuals: A Narrative Review. Infect Dis Ther 2022; 11:1391-1414. [PMID: 35614299 PMCID: PMC9132351 DOI: 10.1007/s40121-022-00648-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/21/2022] [Indexed: 01/04/2023] Open
Abstract
Immunocompromised individuals are at high risk of poor coronavirus disease 2019 (COVID-19) outcomes and demonstrate a lower immune response to COVID-19 vaccines, including to the novel mRNA vaccines that have been shown to elicit high neutralizing antibody levels. This review synthesized available data on the immune response to COVID-19 and critically assessed mRNA COVID-19 vaccine immunogenicity in this vulnerable subpopulation. Patients with various immunocompromising conditions exhibit diverse responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and COVID-19 severity and mortality, and available vaccines elicit lower immune responses, particularly in solid organ transplant recipients. Strategies to improve vaccine responses in immunocompromised individuals are being implemented in vaccine recommendations, including the use of a third and fourth vaccine dose beyond the two-dose series. Additional doses may enhance vaccine effectiveness and help provide broad coverage against emerging SARS-CoV-2 variants. Continued investigation of vaccines and dosing regimens will help refine approaches to help protect this vulnerable subpopulation from COVID-19.
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Affiliation(s)
| | | | | | - Amit Srivastava
- Vaccines, Medical Development, Scientific and Clinical Affairs, Pfizer Inc, 300 Technology Square, 3rd Floor, Cambridge, MA, 02139, USA.
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Li Y, Yang Q, Ding J. Metagenomic Next-generation Sequencing: Application in Infectious Diseases. EXPLORATORY RESEARCH AND HYPOTHESIS IN MEDICINE 2022; 7:19-24. [DOI: 10.14218/erhm.2021.00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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11
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Oyelade T, Alqahtani JS, Hjazi AM, Li A, Kamila A, Raya RP. Global and Regional Prevalence and Outcomes of COVID-19 in People Living with HIV: A Systematic Review and Meta-Analysis. Trop Med Infect Dis 2022; 7:tropicalmed7020022. [PMID: 35202217 PMCID: PMC8880028 DOI: 10.3390/tropicalmed7020022] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 01/25/2022] [Accepted: 02/01/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The relationship between HIV (human immunodeficiency virus) and COVID-19 clinical outcome is uncertain, with conflicting data and hypotheses. We aimed to assess the prevalence of people living with HIV (PLWH) among COVID-19 cases and whether HIV infection affects the risk of severe COVID-19 or related death at the global and continental level. Methods: Electronic databases were systematically searched in July 2021. In total, 966 studies were screened following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Narratives were synthesised and data pooled for the global and continental prevalence of HIV–SARS-CoV-2 coinfection. The relative risks of severity and mortality in HIV-infected COVID-19 patients were computed using a random-effect model. Risk of bias was assessed using the Newcastle–Ottawa score and Egger’s test, and presented as funnel plots. Results: In total, 43 studies were included involving 692,032 COVID-19 cases, of whom 9097 (1.3%) were PLWH. The global prevalence of PLWH among COVID-19 cases was 2% (95% CI = 1.7–2.3%), with the highest prevalence observed in sub-Saharan Africa. The relative risk (RR) of severe COVID-19 in PLWH was significant only in Africa (RR = 1.14, 95% CI = 1.05–1.24), while the relative risk of mortality was 1.5 (95% CI = 1.45–2.03) globally. The calculated global risk showed that HIV infection may be linked with increased COVID-19 death. The between-study heterogeneity was significantly high, while the risk of publication bias was not significant. Conclusions: Although there is a low prevalence of PLWH among COVID-19 cases, HIV infection may increase the severity of COVID-19 in Africa and increase the risk of death globally.
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Affiliation(s)
- Tope Oyelade
- Institute for Liver and Digestive Health, Division of Medicine, University College London, London NW3 2PF, UK
- Correspondence: ; Tel.: +44(0)-20-7679-5203
| | - Jaber S. Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam 34313, Saudi Arabia;
| | - Ahmed M. Hjazi
- Centre for Haematology, Department of Inflammatory and Inflammation, College of Medicine, Imperial College London, London W12 0NN, UK;
| | - Amy Li
- Division of Surgery and Interventional Science, University College London, London NW3 2PS, UK;
| | - Ami Kamila
- Faculty of Science, Universitas ‘Aisyiyah Bandung, Bandung 40264, Indonesia; (A.K.); (R.P.R.)
| | - Reynie Purnama Raya
- Faculty of Science, Universitas ‘Aisyiyah Bandung, Bandung 40264, Indonesia; (A.K.); (R.P.R.)
- Institute for Global Health, Faculty of Population Health Sciences, University College London, London NW3 2PF, UK
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Iliyasu Z, Kwaku AA, Umar AA, Tsiga-Ahmed F, Nass NS, Abdullahi HM, Amole TG, Salihu HM, Aliyu MH. Predictors of COVID-19 vaccine acceptability among patients living with HIV in northern Nigeria: A mixed methods study. Curr HIV Res 2021; 20:82-90. [PMID: 34923948 DOI: 10.2174/1570162x19666211217093223] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/15/2021] [Accepted: 10/05/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND People living with HIV (PLHIV) are at increased risk of COVID-19 acquisition, severe disease, and poor outcomes. Yet, little is known about COVID-19 vaccine hesitancy among PLHIV in high HIV burden countries such as Nigeria. OBJECTIVE This study aims to assess the acceptability of the COVID-19 vaccine and identify predictors and reasons for vaccine hesitancy among patients living with HIV and attending a tertiary hospital in Kano, northern Nigeria. METHODS Using a mixed-methods design, structured questionnaires were administered to a clinic-based sample of patients living with HIV (n=344), followed by 20 in-depth interviews with a sub-sample. Logistic regression and the framework approach were used to analyze the data. RESULTS Less than half (46.2%, n=159) of the respondents were willing to take the COVID-19 vaccine. Vaccine acceptance was higher among non-Muslim PLHIV (Adjusted Odds Ratio (aOR)=1.26, 95% Confidence Interval (95%CI): 1.10-4.00), persons with high-risk perception (aOR=2.43, 95%CI:1.18-5.00), those who were not worried about infertility-related rumors (aOR=13.54, 95%CI:7.07-25.94) and persons who perceived antiretroviral drugs are protective against COVID-19 (aOR = 2.76, 95%CI: 1.48-5.14). In contrast, vaccine acceptance was lower among persons who were not more concerned about the potential effects of COVID-19-HIV co-infection (aOR=0.20, 95%CI:0.10-0.39). The most common reasons for vaccine hesitancy included doubts about the existence of COVID-19, low-risk perception, anxiety about antiretroviral treatment-vaccine interactions, safety concerns, and infertility-related rumors. CONCLUSION Covid-19 vaccine acceptance was low among PLHIV. COVID-19 vaccine acceptance was associated with respondents' faith, risk perception, perception of the protective effects of antiretroviral treatment, concerns about COVID-19-HIV co-infection, and infertility-related rumors. Vaccination counseling should be integrated into HIV treatment services to improve COVID-19 vaccine uptake among PLHIV in Kano and similar settings.
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Affiliation(s)
- Zubairu Iliyasu
- Department of Community Medicine, Bayero University, Kano, Nigeria
| | - Aminatu A Kwaku
- Department of Community Medicine, Bayero University, Kano, Nigeria
| | - Amina A Umar
- Department of Community Medicine, Bayero University, Kano, Nigeria
| | | | - Nafisa S Nass
- Department of Community Medicine, Bayero University, Kano, Nigeria
| | - Hadiza M Abdullahi
- Department of Community Medicine, Aminu Kano Teaching Hospital , Nigeria
| | - Taiwo G Amole
- Department of Community Medicine, Bayero University, Kano, Nigeria
| | - Hamisu M Salihu
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, United States
| | - Muktar Hassan Aliyu
- Department of Health Policy & Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Tennessee, United States
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Barbera LK, Kamis KF, Rowan SE, Davis AJ, Shehata S, Carlson JJ, Johnson SC, Erlandson KM. HIV and COVID-19: review of clinical course and outcomes. HIV Res Clin Pract 2021; 22:102-118. [PMID: 34514963 PMCID: PMC8442751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Background:Understanding the relationship between HIV and SARS-CoV-2 has important public health implications.Objective:To summarize current research on COVID-19 among people with HIV (PWH) as published through 15 July 2021.Methods: We conducted a search of PubMed, Scopus, preprint databases (medRxiv, bioRxiv), and the references of publications found using key terms relevant to COVID-19 ('COVID-19' OR 'SARS-CoV-2' OR 'coronavirus') AND to HIV ('HIV' OR 'Human Immunodeficiency Virus' OR 'AIDS' OR 'Acquired Immunodeficiency Syndrome'). We summarized all articles that reported data or opinions on SARS-CoV-2 and HIV coinfection.Conclusions: Although many initial case series and cohort studies found no increased risk for SARS-CoV-2 infection or severe COVID-19 outcomes among PWH, recent studies have signaled an increased risk for severe COVID-19 disease progression even in the setting of well-controlled HIV. Whether this is due to the increased prevalence of comorbidities in PWH and other social determinants of health is unknown. These conflicting findings highlight the continued need for COVID-19 related research among PWH that addresses COVID-19 disease course as well as exacerbation of existing comorbidities already disproportionately represented among PWH.
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Affiliation(s)
| | | | - Sarah E. Rowan
- Denver Public Health, Denver, CO, USA
- Denver Health, Division of Infectious Diseases, Denver, CO, USA
- University of Colorado, Department of Medicine, Division of Infectious Diseases, University of Colorado, Aurora, CO, USA
| | | | - Soraya Shehata
- University of Colorado, School of Medicine, Aurora, CO, USA
| | | | - Steven C. Johnson
- University of Colorado, Department of Medicine, Division of Infectious Diseases, University of Colorado, Aurora, CO, USA
| | - Kristine M. Erlandson
- University of Colorado, Department of Medicine, Division of Infectious Diseases, University of Colorado, Aurora, CO, USA
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Dong Y, Li Z, Ding S, Liu S, Tang Z, Jia L, Liu J, Liu Y. HIV infection and risk of COVID-19 mortality: A meta-analysis. Medicine (Baltimore) 2021; 100:e26573. [PMID: 34190201 PMCID: PMC8257842 DOI: 10.1097/md.0000000000026573] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/09/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND This meta-analysis aimed to estimate the association of human immunodeficiency virus (HIV) infection and risk of coronavirus disease 2019 (COVID-19) mortality. METHODS We systematically retrieved articles published on HIV infection and risk of COVID-19 mortality through PubMed, EMBase, China National Knowledge Infrastructure, WanFang, and Chongqing VIP databases using a predefined search strategy from December 1, 2019 to January 31, 2021. Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included studies. Cochran Q test and I2 statistics were quantified to measure heterogeneity. Odds ratio (OR) and 95% confidence intervals (CI) were computed and displayed in the form of forest plots. Subgroup analysis was performed to explore the source of heterogeneity. Funnel plot, Begg test, and Egger test were used to assess potential publication bias. Stata software version 11.0 was used to analyze all the statistical data. RESULTS We included 10 studies with 18,122,370 COVID-19 patients, of whom 41,113 were with HIV infection and 18,081,257 were without HIV infection. The pooled overall results suggested that people living with HIV infection had a higher risk of mortality from COVID-19 than those without HIV infection (OR = 1.252, 95% CI 1.027-1.524). Subgroup analysis showed that people living with HIV infection had a higher risk of COVID-19 mortality than those without HIV infection in the United States (OR = 1.520, 95% CI 1.252-1.845) and in South Africa (OR = 1.122, 95% CI 1.032-1.220); however, no significant association was found in the United Kingdom (OR = 0.878, 95% CI 0.657-1.174). CONCLUSION Patients with HIV infection should be the emphasis population to prevent the risk of mortality during the clinical treatment of COVID-19 patients.
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Affiliation(s)
- Yonghai Dong
- Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, Jiangxi, China
| | - Zhongjian Li
- Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, Jiangxi, China
| | - Sheng Ding
- Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, Jiangxi, China
| | - Shulong Liu
- Department of Hospital Infection Management, Jiangxi Provincial Chest Hospital, Nanchang, Jiangxi, China
| | - Zhiyuan Tang
- Department of Data Collection, Jiangxi Provincial Center for Health Monitoring and Evaluation, Nanchang, Jiangxi, China
| | - Lina Jia
- Department of Hospital Accreditation, Jiangxi Provincial Center for Health Development, Nanchang, Jiangxi, China
| | - Jiahong Liu
- Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, Jiangxi, China
| | - Yun Liu
- Department of Imaging, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, Jiangxi, China
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Tenofovir, Another Inexpensive, Well-Known and Widely Available Old Drug Repurposed for SARS-COV-2 Infection. Pharmaceuticals (Basel) 2021; 14:ph14050454. [PMID: 34064831 PMCID: PMC8150375 DOI: 10.3390/ph14050454] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/01/2021] [Accepted: 05/05/2021] [Indexed: 12/18/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is spreading worldwide with different clinical manifestations. Age and comorbidities may explain severity in critical cases and people living with human immunodeficiency virus (HIV) might be at particularly high risk for severe progression. Nonetheless, current data, although sometimes contradictory, do not confirm higher morbidity, risk of more severe COVID-19 or higher mortality in HIV-infected people with complete access to antiretroviral therapy (ART). A possible protective role of ART has been hypothesized to explain these observations. Anti-viral drugs used to treat HIV infection have been repurposed for COVID-19 treatment; this is also based on previous studies on severe acute respiratory syndrome virus (SARS-CoV) and Middle East respiratory syndrome virus (MERS-CoV). Among them, lopinavir/ritonavir, an inhibitor of viral protease, was extensively used early in the pandemic but it was soon abandoned due to lack of effectiveness in clinical trials. However, remdesivir, a nucleotide analog that acts as reverse-transcriptase inhibitor, which was tested early during the pandemic because of its wide range of antiviral activity against several RNA viruses and its safety profile, is currently the only antiviral medication approved for COVID-19. Tenofovir, another nucleotide analog used extensively for HIV treatment and pre-exposure prophylaxis (PrEP), has also been hypothesized as effective in COVID-19. No data on tenofovir's efficacy in coronavirus infections other than COVID-19 are currently available, although information relating to SARS-CoV-2 infection is starting to come out. Here, we review the currently available evidence on tenofovir's efficacy against SARS-CoV-2.
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Byrareddy SN. Meet Our Editorial Board Member. Curr HIV Res 2021. [DOI: 10.2174/1570162x1903210401104648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Siddappa N. Byrareddy
- Department of Pharmacology and Experimental Neurosciences University of Nebraska Medical Center Omaha, NE, United States
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Roest S, Brugts JJ, van Kampen JJA, von der Thüsen JH, Constantinescu AA, Caliskan K, Hirsch A, Manintveld OC. COVID-19-related myocarditis post-heart transplantation. Int J Infect Dis 2021; 107:34-36. [PMID: 33862215 PMCID: PMC8056480 DOI: 10.1016/j.ijid.2021.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 01/23/2023] Open
Abstract
This report describes the first heart transplantation recipient with acute biventricular heart failure symptoms caused by a post-myocarditis state, late after a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. No other viral pathogens could be detected. Computed tomography angiography did not show cardiac allograft vasculopathy, and myocardial biopsy demonstrated no clinically relevant rejection. Subsequent cardiovascular magnetic resonance imaging revealed extensive epicardial delayed enhancement without myocardial edema. Heart failure medication was initiated and an implantable cardioverter defibrillator was implanted (due to non-sustained ventricular tachycardias), leading to a partial recovery of the ejection fraction. Further studies are needed to investigate the number of heart transplant recipients with myocardial damage after a SARS-CoV-2 infection.
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Affiliation(s)
- Stefan Roest
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jeroen J A van Kampen
- Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan H von der Thüsen
- Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alina A Constantinescu
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alexander Hirsch
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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