Having HIV does not by itself make it likelier for a person with COVID-19 to need hospitalization, a new retrospective study presented at IDWeek 2020 found. The findings add to a growing body of research showing that it’s other co-morbidities, not HIV, that lead to worse health outcomes from COVID-19—at least among individuals who are on stable antiretroviral therapy.
Michael D. Virata, M.D., an assistant professor of clinical medicine at Yale University School of Medicine, and his team performed a retrospective chart review of people living with HIV (PLWH) who were diagnosed with COVID-19 between March 1 and July 21 at Yale New Haven Hospital in New Haven, Connecticut, and who also received their HIV care at the hospital’s ambulatory center.
This was an older cohort, and the average length of time living with HIV for all 48 was 14 years. Ninety-eight percent of patients had been prescribed antiretrovirals to treat HIV.
Among the population of 1,469 PLWH, 48 (3.3%) were diagnosed with COVID-19 during the study period; of that 48, 19 (1.3% of the total cohort) were treated as inpatients and 29 were outpatients. The median age of PLWH diagnosed with COVID-19 was 56 years, and just over half were women.
A significant number of the 48 PLWH diagnosed with COVID-19 had comorbid conditions, including hypertension (24), obesity (22), cardiovascular disease (19), chronic lung disease (19), and diabetes (14). More than two thirds (33) were current or former smokers. Two-thirds (32) had more than one comorbidity.
The good news: No deaths occurred among the 48 individuals within 30 days of their COVID-19 diagnosis. More significantly, PLWH who experienced similar comorbidities to HIV-negative people did not appear to have a greater risk of hospitalization, when these findings were compared to other known data regarding COVID-19 outcomes in the general population. In addition, the course of illness for COVID-19 among PLWH was similar to what has been seen among HIV-negative patients.
Although all hospitalized PLWH with COVID-19 were able to maintain viral suppression without altering their antiretroviral regimen, a few experienced a decline in CD4 count due to the acute COVID-related illness.
The team found a few factors associated with the need for hospitalization due to COVID-19 among PLWH in the study, compared to those receiving outpatient care:
People with cardiovascular disease were two and a half times more likely to be hospitalized.
People with diabetes were twice as likely to be hospitalized.
People over 49 years old were 60% more likely to be hospitalized.
In an interview with TheBodyPro, Virata noted that not all patients were given the same treatment for COVID-19. “Early in the pandemic, there was uncertainty about what [medications] to provide,” he said. “Our initial treatment algorithm included hydroxychloroquine, which was later discontinued; one patient was given [the HIV protease inhibitor] lopinavir when that looked promising. Some with more severe COVID-19 symptoms got remdesivir.”
Overall, Virata said his team was encouraged by the good short-term outcomes, but that more study was required to understand the long-term impact of COVID-19 on PLWH. He acknowledged the limitations of his study—primarily that it’s a small, retrospective review at a specific institution that may not be representative of the HIV-positive population generally.
“Our cohort was older, with multiple comorbid conditions, but had access to a variety of experimental treatments and elevated levels of care that may account for more favorable outcomes,” Virata said. “These interventions may not be available at other health care settings.”
Nonetheless, Virata said that the results of the study should encourage clinicians and other health care workers to not make any radical changes in a patient’s antiretroviral therapy if they develop COVID-19. Some earlier research had suggested that specific antiretroviral combinations could decrease COVID-19 risks, but in this study there was no signal that choice of regimens had any effect on the clinical outcome or course of COVID-19.
Virata also stressed that care providers needed to be mindful of the status of comorbid illnesses, such as hypertension, in PLWH who present with COVID-19. “These comorbidities should, first, be identified, and well controlled,” he said.