Preprints with The Lancet is part of SSRN´s First Look, a place where journals identify content of interest prior to publication. Authors have opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early stage research papers that have not been peer-reviewed. The findings should not be used for clinical or public health decision making and should not be presented to a lay audience without highlighting that they are preliminary and have not been peer-reviewed. For more information on this collaboration, see the comments published in The Lancet about the trial period, and our decision to make this a permanent offering, or visit The Lancet´s FAQ page, and for any feedback please contact email@example.com.
COVID-19 in HIV-Infected Individuals: Preliminary Results of a Prospective Cohort
35 Pages Posted: 2 Jun 2020More...
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.
Keywords: SARS-CoV-2; coronavirus disease 19; HIV; cohort; clinical characteristics; infection rate; Spain
Suggested Citation: Suggested Citation