2. Fellow, Department of Medicine (Infectious Diseases), Albert Einstein College of Medicine, USA.
3. Medical Resident, Department of Medicine, Albert Einstein College of Medicine, USA.
4. Study Coordinator, Department of Medicine, Albert Einstein College of Medicine, USA.
5. Project Manager, Children’s Hospital at Montefiore, USA.
6. Associate Professor of Medicine (Infectious Diseases), Albert Einstein College of Medicine, USA.
7. Assistant Professor of Medicine (Infectious Diseases), Albert Einstein College of Medicine, USA.
Objective: The purpose of this study is to investigate potential factors associated with patient survival (primary outcome) and need for mechanical ventilation (secondary outcome) for people living with HIV (PLWH) who have COVID-19.
Design: This retrospective, observational cohort study was conducted from January 1, 2020 to April 30, 2020. Thirty-day readmissions were observed from January 1, 2020 to May 31, 2020.
Setting: Montefiore Medical Center is a large academic institution dispersed over three campuses located in Bronx County, NY. Bronx County has the highest prevalence of HIV in the United States, the fifthhighest prevalence of confirmed COVID-19 cases, and the fourth-highest prevalence of COVID-19 deaths across the United States, as of June 2020, according to the Johns Hopkins Coronavirus Resource Center.
Participants: Patients were included in the cohort if they had an ICD-10 code corresponding to HIV infection (B20) and a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) PCR test during the study period.
Main Outcome(s) and Measure(s): The primary outcome was survivorship. PLWH who survived COVID-19 were compared with those who did not. As a secondary outcome, PLWH who required mechanical ventilation were compared with those who did not.
Results: Seventy-two PLWH had positive SARS-CoV-2 PCR tests during the study period. Of these, 28 were female (39%), and the median [IQR] age was 62 [+/-16] years. The median CD4+ count was 235 cells/uL, and 11 patients (15%) had an HIV viral load =200 copies/mL. Twenty patients (27.8%) did not survive. All 11 patients (15%) who had a detectable HIV viral load at the start of the study period survived (p=0.02). Patients who did not survive were more likely to have chronic kidney disease (p<0.01), acute kidney injury (p<0.01), higher absolute neutrophil counts (p<0.01), and higher IL-6 levels (p<0.01) than those who survived. Fifteen patients (20.8%) required mechanical ventilation, and three of those patients (4.1%) survived. Patients who required mechanical ventilation were more likely to be obese (p<0.01) and to have higher absolute neutrophil counts (p=0.01) than those who did not need mechanical ventilation.
Conclusion: PLWH may be at higher risk of morbidity and mortality related to COVID-19 than the general population because of underlying co-morbidities. All patients in the study cohort who died had an undetectable HIV viral load; this finding suggests that patients with uncontrolled HIV are not at a higher risk of mortality than patients with controlled HIV in the setting of COVID-19.
Keywords: Covid-19, HIV, Survival