Immune deficiency is a risk factor for severe COVID-19 in people living with HIV
Immune deficiency is a risk factor for severe COVID-19 in people living with HIV
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DOI：
10.1111/hiv.13037
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发表时间：
2020-12-27
期刊：
影响因子：
3
通讯作者：
Gervasoni, Cristina
中科院分区：
文献类型：
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作者：
Hoffmann, Christian;Casado, Jose L.;Gervasoni, Cristina
目的在当前的COVID-19大流行中，HIV感染诱导的先前T细胞耗竭可能带来有害后果。HIV和SARS-CoV-2合并感染患者的临床数据仍然稀缺。方法本多中心队列研究评估了三个国家不同临床环境中感染SARS-CoV-2的HIV感染者（PLWH）COVID-19发病率和死亡率的危险因素。结果175例患者中，重度49例（28%），死亡7例（4%）。几乎所有患者都在接受抗逆转录病毒治疗（ART），94%的患者在COVID-19诊断前HIV RNA低于50拷贝/mL。在单变量分析中，年龄50岁或以上、CD 4 + T细胞最低值< 200/mu l、当前CD 4 + T细胞< 350/mu l和存在至少一种合并症与COVID-19的严重程度显著相关。没有发现性别、种族、肥胖、可检测到的HIV RNA、先前的艾滋病定义疾病或替诺福韦有显著关联在多变量分析中，与严重COVID-19风险相关的唯一因素是当前CD 4 + T细胞计数< 350/mu l。（调整的比值比2.85，95%置信区间1.26-6.44，p=0.01）。与死亡率相关的唯一因素是低CD 4 T细胞最低点。结论在PLWH中，免疫缺陷是严重COVID-19的可能风险因素，即使在病毒学抑制的情况下。没有证据表明PI或替诺福韦艾拉酚胺具有保护作用。
Objectives A prior T cell depletion induced by HIV infection may carry deleterious consequences in the current COVID-19 pandemic. Clinical data on patients co-infected with HIV and SARS-CoV-2 are still scarce.Methods This multicentre cohort study evaluated risk factors for morbidity and mortality of COVID-19 in people living with HIV (PLWH), infected with SARS-CoV-2 in three countries in different clinical settings. COVID-19 was clinically classified as to be mild-to-moderate or severe.Results Of 175 patients, 49 (28%) had severe COVID-19 and 7 (4%) patients died. Almost all patients were on antiretroviral therapy (ART) and in 94%, HIV RNA was below 50 copies/mL prior to COVID-19 diagnosis. In the univariate analysis, an age 50 years or older, a CD4+ T cell nadir of < 200/mu l, current CD4+ T cells < 350/mu l and the presence of at least one comorbidity were significantly associated with severity of COVID-19. No significant association was found for gender, ethnicity, obesity, a detectable HIV RNA, a prior AIDS-defining illness, or tenofovir (which was mainly given as alafenamide) or protease inhibitor use in the current ART. In a multivariate analysis, the only factor associated with risk for severe COVID-19 was a current CD4+ T cell count of < 350/mu l (adjusted odds ratio 2.85, 95% confidence interval 1.26-6.44, p=0.01). The only factor associated with mortality was a low CD4 T cell nadir.Conclusions In PLWH, immune deficiency is a possible risk factor for severe COVID-19, even in the setting of virological suppression. There is no evidence for a protective effect of PIs or tenofovir alafenamide.