Description of COVID-19 in HIV-infected individuals: a single-centre, prospective cohort
Description of COVID-19 in HIV-infected individuals: a single-centre, prospective cohort
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DOI：
10.1016/s2352-3018(20)30164-8
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发表时间：
2020-08-01
期刊：
影响因子：
16.1
通讯作者：
Casado, Jose L.
中科院分区：
文献类型：
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作者：
Vizcarra, Pilar;Perez-Elias, Maria J.;Casado, Jose L.
关于hiv感染者合并严重急性呼吸综合征冠状病毒2 （SARS-CoV-2）感染的发病率、临床特征和结局的信息很少。我们在马德里的hiv感染成人队列中对COVID-19个体进行了特征分析。方法在这项观察性前瞻性研究中，我们纳入了截至2020年4月30日在西班牙马德里RamOn y Cajal大学医院（Hospital Universitario RamOn y Cajal）怀疑或确诊COVID-19的所有连续hiv感染者（年龄bb0 = 18岁）。我们将COVID-19感染者的特征与COVID-19大流行前评估的hiv感染者样本进行了比较，并描述了COVID-19感染者的结局。51例hiv感染者被诊断为COVID-19（发病率1.8%,95% CI 1.3-2.3）。患者平均年龄53.3岁(SD 9.5);8名（16%）女性，43名（84%）男性。合并感染35例(69%)实验室确诊COVID-19, 28例(55%)需要住院治疗。51例被诊断为COVID-19的患者的年龄和CD4细胞计数与1288例未被诊断为COVID-19的hiv感染者相似；然而，32名（63%）患有COVID-19的患者至少有一种合并症（主要是高血压和糖尿病），而没有COVID-19的患者为495名（38%）（p=0.00059）。37例（73%）患者在COVID-19诊断前接受了替诺福韦治疗，而未确诊的患者中有487例（38%）接受了替诺福韦治疗（p=0.0036）；在COVID-19组中，11人（22%）以前使用过蛋白酶抑制剂（主要是darunavir），而175人（14%;13=0.578）。hiv感染者中COVID-19的临床、分析和放射学表现与一般人群相似。6例（12%）危重患者，其中2例CD4细胞计数低于200个/ pL， 2例（4%）死亡。在6名（32%）患者中，SARS-CoV-2 RT-PCR在症状出现后中位数40天后仍呈阳性，其中4名患者病情严重或CD4细胞计数低。艾滋病毒感染者不应被认为可以免受SARS-CoV-2感染或具有较低的严重疾病风险。一般来说，他们应该接受适用于一般人群的相同治疗方法。
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 characterised individuals with COVID-19 among a cohort of HIV-infected adults in Madrid.Methods In this observational prospective study, we included all consecutive HIV-infected individuals (aged >= 18 years) who had suspected or confirmed COVID-19 as of April 30,2020, at the Hospital Universitario RamOn y Cajal (Madrid, Spain). We compared the characteristics of HIV-infected individuals with COVID-19 with a sample of HIV-infected individuals assessed before the COVID-19 pandemic, and described the outcomes of individuals with COVID-19.Findings 51 HIV-infected individuals were diagnosed with COVID-19 (incidence 1.8%, 95% CI 1.3-2.3). Mean age of patients was 53.3 years (SD 9.5); eight (16%) were women, and 43 (84%) men. 35 (69%) cases of co-infection had laboratory confirmed COVID-19, and 28 (55%) required hospital admission. Age and CD4 cell counts in 51 patients diagnosed with COVID-19 were similar to those in 1288 HIV-infected individuals without; however, 32 (63%) with COVID-19 had at least one comorbidity (mostly hypertension and diabetes) compared with 495 (38%) without COVID-19 (p=0.00059). 37 (73%) patients had received tenofovir before COVID-19 diagnosis compared with 487 (38%) of those without COVID-19 (p=0.0036); 11 (22%) in the COVID-19 group had previous protease inhibitor use (mostly darunavir) compared with 175 (14%; 13=0.578). Clinical, analytical, and radiological presentation of COVID-19 in HIV-infected individuals was similar to that described in the general population. Six (12%) individuals were critically ill, two of whom had CD4 counts of less than 200 cells per pL, and two (4%) died. SARS-CoV-2 RT-PCR remained positive after a median of 40 days from symptoms onset in six (32%) individuals, four of whom had severe disease or low nadir CD4 cell counts.Interpretation HIV-infected individuals should not be considered to be protected from SARS-CoV-2 infection or to have lower risk of severe disease. Generally, they should receive the same treatment approach applied to the general population.