Ministry of Health, Madrid, Spain (J.D., R.P.).
University Hospital Ramón y Cajal and HIV Network of Excellence, Madrid, Spain (S.M.).
Ann Intern Med. 2020 Oct 6;173(7):536-541. doi: 10.7326/M20-3689. Epub 2020 Jun 26.
The incidence and severity of coronavirus disease 2019 (COVID-19) among HIV-positive persons receiving antiretroviral therapy (ART) have not been characterized in large populations.
To describe the incidence and severity of COVID-19 by nucleos(t)ide reverse transcriptase inhibitor (NRTI) use among HIV-positive persons receiving ART.
Cohort study.
HIV clinics in 60 Spanish hospitals between 1 February and 15 April 2020.
77 590 HIV-positive persons receiving ART.
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 alafenamide (TAF)/FTC, abacavir (ABC)/lamivudine (3TC), and others were estimated through Poisson regression models.
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 diagnosis 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.
Residual confounding by comorbid conditions cannot be completely excluded.
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.
Instituto de Salud Carlos III and National Institutes of Health.
在接受抗逆转录病毒疗法（ART）的艾滋病毒阳性人群中，冠状病毒病 2019（COVID-19）的发病率和严重程度尚未在大规模人群中得到描述。
描述接受 ART 的艾滋病毒阳性人群中使用核苷（酸）逆转录酶抑制剂（NRTI）的 COVID-19 的发病率和严重程度。
队列研究。
2020 年 2 月 1 日至 4 月 15 日期间，西班牙 60 家医院的 HIV 诊所。
77590 名接受 ART 的艾滋病毒阳性者。
每 10000 人估计的聚合酶链反应（PCR）确诊 COVID-19 诊断、住院、重症监护病房（ICU）入院和死亡的风险（累积发生率）和 95%CI。通过泊松回归模型估计使用富马酸替诺福韦二吡呋酯（TDF）/恩曲他滨（FTC）、替诺福韦艾拉酚胺（TAF）/FTC、阿巴卡韦（ABC）/拉米夫定（3TC）和其他 NRTI 的 COVID-19 诊断和住院风险及其 95%CI。
在 77590 名接受 ART 的艾滋病毒阳性者中，有 236 人被诊断患有 COVID-19，151 人住院，15 人入住 ICU，20 人死亡。男性和年龄大于 70 岁的患者 COVID-19 诊断和住院的风险更高。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/3TC 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）。没有接受 TDF/FTC 的患者入住 ICU 或死亡。
无法完全排除合并症引起的残余混杂因素。
接受 TDF/FTC 的艾滋病毒阳性患者 COVID-19 风险及其相关住院治疗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。
西班牙卡洛斯三世健康研究所和美国国立卫生研究院。
