Division of Infectious Diseases, Department of Medicine, The Brown Alpert Medical School and The Miriam Hospital, Providence, RI, USA.
J Int AIDS Soc. 2020 Jul;23(7):e25573. doi: 10.1002/jia2.25573.
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has infected >6 million people worldwide since December 2019. Global reports of HIV/SARS-CoV-2 coinfection are limited. To better understand the impact of the coronavirus disease 2019 (COVID-19) pandemic on persons with HIV and improve their care, we present an outpatient and inpatient clinical experience of HIV/SARS-CoV-2 coinfection from Rhode Island, US.
We describe outpatient and inpatient preparedness for the COVID-19 pandemic, and present a case series of all known patients with HIV/SARS-CoV-2 coinfection at The Miriam Hospital and Rhode Island Hospital, and The Miriam Hospital Infectious Diseases and Immunology Center, in Providence, Rhode Island, US.
The Infectious Diseases and Immunology Center rapidly prepared for outpatient and inpatient care of persons with HIV and SARS-CoV-2. Between 30 March and 20 May 2020, 27 patients with HIV were diagnosed with SARS-CoV-2. Twenty were male, six female and one transgender female; average age was 49 years; 13/27 were Hispanic and 6/27 were African American. All had HIV viral load <200 copies/mL and were on antiretroviral therapy with CD4 count range 87 to 1441 cells/µL. Twenty-six of the 27 had common COVID-19 symptoms for one to twenty-eight days and most had other co-morbidities and/or risk factors. Nine of the 27 were hospitalized for one to thirteen days; of those, three lived in a nursing home, six received remdesivir through a clinical trial or emergency use authorization and tolerated it well; eight recovered and one died. Overall, 17% of known Center people had HIV/SARS-CoV-2 coinfection, whereas the comparable state-wide prevalence was 9%.
We highlight challenges of outpatient and inpatient HIV care in the setting of the COVID-19 pandemic and present the largest detailed case series to date from the United States on HIV/SARS-CoV-2 coinfection, adding to limited global reports. The aggregated clinical findings suggest that the clinical presentation and outcomes of COVID-19 appear consistent with those without HIV. Whether SARS-CoV-2 infection is more frequent among persons with HIV remains to be determined. More data are needed as we develop our understanding of how HIV and antiretroviral therapy are affected by or have an impact on this pandemic.
自 2019 年 12 月以来，严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2）已在全球感染了超过 600 万人。全球关于艾滋病毒/ SARS-CoV-2 合并感染的报告有限。为了更好地了解 2019 年冠状病毒病（COVID-19）大流行对艾滋病毒感染者的影响并改善其护理，我们在美国罗得岛州介绍了艾滋病毒/ SARS-CoV-2 合并感染的门诊和住院临床经验。
我们描述了 COVID-19 大流行期间门诊和住院的准备情况，并介绍了美国罗得岛州普罗维登斯市米里亚姆医院和罗德岛医院以及米里亚姆医院传染病和免疫学中心所有已知 HIV/SARS-CoV-2 合并感染患者的病例系列。
传染病和免疫学中心迅速为艾滋病毒和 SARS-CoV-2 感染者的门诊和住院治疗做准备。在 2020 年 3 月 30 日至 5 月 20 日之间，有 27 名艾滋病毒感染者被诊断出患有 SARS-CoV-2。20 名男性，6 名女性和 1 名跨性别女性；平均年龄为 49 岁；27 人中 13 人为西班牙裔，6 人为非裔美国人。所有人的 HIV 病毒载量均<200 拷贝/mL，并且正在接受抗逆转录病毒治疗，CD4 计数范围为 87 至 1441 个细胞/µL。27 例中有 26 例出现了一至二十八天的常见 COVID-19 症状，大多数人还有其他合并症和/或危险因素。27 例中有 9 例住院治疗一至十三天；其中三人住在养老院，六人接受了瑞德西韦的临床试验或紧急使用授权，并且耐受性良好；八人康复，一人死亡。总体而言，该中心已知人群中有 17％的人患有 HIV/SARS-CoV-2 合并感染，而全州范围内的这一比例为 9％。
我们强调了 COVID-19 大流行期间门诊和住院艾滋病毒护理所面临的挑战，并介绍了迄今为止美国在 HIV/SARS-CoV-2 合并感染方面最大的详细病例系列，补充了有限的全球报告。汇总的临床发现表明，COVID-19 的临床表现和结果与没有 HIV 的患者一致。艾滋病毒感染者中 SARS-CoV-2 感染是否更为普遍还有待确定。随着我们对 HIV 和抗逆转录病毒疗法如何受到这一大流行的影响或对其产生影响的理解的发展，还需要更多的数据。
