Incidence and Severity of COVID-19 in HIV-Positive Persons Receiving Antiretroviral Therapy A Cohort Study
Incidence and Severity of COVID-19 in HIV-Positive Persons Receiving Antiretroviral Therapy A Cohort Study
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DOI：
10.7326/m20-3689
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发表时间：
2020-10-06
影响因子：
39.2
通讯作者：
Hernan, Miguel A.
中科院分区：
文献类型：
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作者：
del Amo, Julia;Polo, Rosa;Hernan, Miguel A.
背景资料：在接受抗逆转录病毒治疗（ART）的HIV阳性者中，2019冠状病毒病（COVID-19）的发病率和严重程度尚未在大规模人群中得到表征。目的：通过在接受ART的HIV阳性者中使用核苷（酸）逆转录酶抑制剂（NRTI）来描述COVID-19的发病率和严重程度。设计：队列研究。设定：2020年2月1日至4月15日期间，西班牙60家医院的艾滋病诊所。参与者：77590名接受抗逆转录病毒治疗的艾滋病病毒阳性者。测量：聚合酶链反应确诊的COVID-19诊断、住院、重症监护室（ICU）入院和死亡的估计风险（累积发病率）/10000人和95%CI。通过Poisson回归模型估计了使用NRTI替诺福韦酯/恩曲他滨（TDF）、替诺福韦艾拉酚胺（TAF）/FTC、阿巴卡韦（ABC）/拉米夫定（3 TC）等的COVID-19诊断和住院的风险和95% CI。在77590名接受ART的艾滋病毒阳性者中，236人被诊断出患有COVID-19，151人住院，15人入住ICU，20人死亡。男性和70岁以上人群的COVID-19诊断和住院风险更大。接受TAF/FTC的患者COVID-19住院的风险为20.3（95% CI，15.2至26.7），接受TDF/FTC的患者为10.5（CI，5.6至17.9），接受ABC/3 TC的患者为23.4（CI，17.2至31.1），接受其他方案的患者为20.0（CI，14.2至27.3）。COVID-19诊断的相应风险分别为39.1（CI，31.8至47.6）、16.9（CI，10.5至25.9）、28.3（CI，21.5至36.7）和29.7（CI，22.6至38.4）。无接受TDF/FTC治疗的患者入住ICU或死亡。局限性：不能完全排除共病的剩余混杂因素。结论：接受TDF/FTC治疗的HIV阳性患者发生COVID-19及相关住院的风险低于接受其他治疗的患者。这些发现值得在HIV暴露前预防研究和无HIV人群的随机试验中进一步研究。
Background: The incidence and severity of coronavirus disease 2019 (COVID-19) among HIV-positive persons receiving anti-retroviral therapy (ART) have not been characterized in large populations.Objective: To describe the incidence and severity of COVID-19 by nucleos(t)ide reverse transcriptase inhibitor (NRTI) use among HIV-positive persons receiving ART.Design: Cohort study. Setting: HIV clinics in 60 Spanish hospitals between 1 February and 15 April 2020.Participants: 77 590 HIV-positive persons receiving ART.Measurements: Estimated risks (cumulative incidences) per 10 000 persons and 95% CIs for polymerase chain reaction-confirmed COVID-19 diagnosis, hospitalization, intensive care unit (ICU) admission, and death. Risk and 95% CIs for COVID-19 diagnosis and hospital admission by use of the NRTIs tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC), tenofovir alafen-amide (TAF)/FTC, abacavir (ABC)/lamivudine (3TC), and others were estimated through Poisson regression models.Results: Of 77 590 HIV-positive persons receiving ART, 236 were diagnosed with COVID-19, 151 were hospitalized, 15 were admitted to the ICU, and 20 died. The risks for COVID-19 diag-nosis and hospitalization were greater in men and persons older than 70 years. The risk for COVID-19 hospitalization was 20.3 (95% CI, 15.2 to 26.7) among patients receiving TAF/FTC, 10.5 (CI, 5.6 to 17.9) among those receiving TDF/FTC, 23.4 (CI, 17.2 to 31.1) among those receiving ABC/3TC, and 20.0 (CI, 14.2 to 27.3) for those receiving other regimens. The corresponding risks for COVID-19 diagnosis were 39.1 (CI, 31.8 to 47.6), 16.9 (CI, 10.5 to 25.9), 28.3 (CI, 21.5 to 36.7), and 29.7 (CI, 22.6 to 38.4), respectively. No patient receiving TDF/FTC was admitted to the ICU or died.Limitation: Residual confounding by comorbid conditions cannot be completely excluded.Conclusion: HIV-positive patients receiving TDF/FTC have a lower risk for COVID-19 and related hospitalization than those receiving other therapies. These findings warrant further investigation in HIV preexposure prophylaxis studies and randomized trials in persons without HIV.