COVID-19 in HIV-Infected Individuals: Preliminary Results of a Prospective Cohort

Abstract

Background: Information about incidence, clinical characteristics and outcomes of HIV-infected individuals with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is scarce. We characterized individuals with coronavirus disease 2019 (COVID-19) among a cohort of HIV-infected adults regularly followed-up at an HIV clinic in Madrid, Spain, one of the most affected cities worldwide.

Methods: In this observational study, we included all consecutive HIV-infected individuals who were diagnosed of suspected or confirmed COVID-19 as of April 14, 2020. Demographic, clinical, treatment, and laboratory data, including HIV-specific information, were extracted from the electronic health records. We compared the characteristics of HIV-infected individuals with COVID-19 with a representative sample of HIV-infected individuals evaluated before the COVID-19 pandemic (n=1,302), and described the evolution and outcomes of individuals with COVID-19 according to baseline characteristics.

Findings: Thirty-seven HIV-infected individuals (mean, 53·5 years; females, 16%) were diagnosed with COVID-19 (incidence, 1·3%, 95% confidence interval: 0·9-1·8%). Of them, 29 (78%) were laboratory confirmed cases, and 26 (70%) required hospitalization. Overall, 29 (78%) individuals had comorbidities, predominantly hypertension and diabetes, higher than that observed among HIV-infected individuals without COVID-19 ( P =0·006). Additionally, a significantly higher percentage of individuals with COVID-19 were receiving tenofovir prior to COVID-19 diagnosis compared to HIV-infected individuals without COVID-19 (70% versus 52%, P =0·030), and the rate of prior protease inhibitor use was similar in both groups (mostly darunavir, 19% versus 18%, P =0·830). Clinical, analytical and radiological presentation of COVID-19 in HIV-infected individuals was similar to that described in the general population: five (14%) were critically-ill, and two (5%) died. Two out of five critically ill individuals had CD4+ counts <200 cells/mm³.

Interpretation: Our findings indicate that COVID-19 predominantly affects HIV-infected individuals with comorbidities. These data do not suggest a protective effect of CD4+ count or previous antiretroviral therapy on the rate of infection or outcomes.

Funding Statement: None.

Declaration of Interests: MJPE has received research grants or honoraria for lectures or for participation in advisory boards from Abbott, Bristol-Myers Squibb, Boehringer Ingelheim, Gilead Sciences, ViiV-Healthcare previously GlaxoSmithKline, Roche, and Janssen; and unrestricted grants from Abbott, ViiVHealthcare previously GlaxoSmithKline, Gilead Sciences and Janssen. For the remaining authors, none was declared.

Ethics Approval Statement: The study protocol was approved by our Institutional Review Board (EC 110/20), and patients provided oral informed consent in order to minimize staff exposure.