武汉市人类免疫缺陷病毒感染者中 2019 年冠状病毒病（COVID-19）病例的流行病学、病毒学和血清学特征：一项基于人群的队列研究。
Epidemiological, Virological and Serological Features of Coronavirus Disease 2019 (COVID-19) Cases in People Living With Human Immunodeficiency Virus in Wuhan: A Population-based Cohort Study.
机构信息
Department of Epidemiology and Biostatistics, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department for HIV/AIDS Control and Prevention, Wuhan Center for Disease Control and Prevention, Wuhan, China.
出版信息
Clin Infect Dis. 2021 Oct 5;73(7):e2086-e2094. doi: 10.1093/cid/ciaa1186.
BACKGROUND
We aimed to describe the epidemiological, virological, and serological features of coronavirus disease 2019 (COVID-19) cases in people living with human immunodeficiency virus (HIV; PLWH).
METHODS
This population-based cohort study identified all COVID-19 cases among all PLWH in Wuhan, China, by 16 April 2020. The epidemiological, virological, and serological features were analyzed based on the demographic data, temporal profile of nucleic acid test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the disease, and SARS-CoV-2-specific immunoglobin (Ig) M and G after recovery.
RESULTS
From 1 January to 16 April 2020, 35 of 6001 PLWH experienced COVID-19, with a cumulative incidence of COVID-19 of 0.58% (95% confidence interval [CI], .42-.81%). Among the COVID-19 cases, 15 (42.86) had severe illness, with 2 deaths. The incidence, case-severity, and case-fatality rates of COVID-19 in PLWH were comparable to those in the entire population in Wuhan. There were 197 PLWH who had discontinued combination antiretroviral therapy (cART), 4 of whom experienced COVID-19. Risk factors for COVID-19 were age ≥50 years old and cART discontinuation. The median duration of SARS-CoV-2 viral shedding among confirmed COVID-19 cases in PLWH was 30 days (interquartile range, 20-46). Cases with high HIV viral loads (≥20 copies/mL) had lower IgM and IgG levels than those with low HIV viral loads (<20 copies/ml; median signal value divided by the cutoff value [S/CO] for IgM, 0.03 vs 0.11, respectively [P < .001]; median S/CO for IgG, 10.16 vs 17.04, respectively [P = .069]).
CONCLUSIONS
Efforts are needed to maintain the persistent supply of antiretroviral treatment to elderly PLWH aged 50 years or above during the COVID-19 epidemic. The coinfection of HIV and SARS-CoV-2 might change the progression and prognosis of COVID-19 patients in PLWH.
背景
本研究旨在描述人类免疫缺陷病毒（HIV）感染者（PLWH）中 2019 年冠状病毒病（COVID-19）病例的流行病学、病毒学和血清学特征。
方法
本基于人群的队列研究通过 2020 年 4 月 16 日，确定了中国武汉所有 PLWH 中的所有 COVID-19 病例。根据人口统计学数据、疾病期间严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）核酸检测的时间分布以及恢复后 SARS-CoV-2 特异性免疫球蛋白（Ig）M 和 G，分析了流行病学、病毒学和血清学特征。
结果
从 2020 年 1 月 1 日至 4 月 16 日，6001 名 PLWH 中有 35 名经历了 COVID-19，COVID-19 的累积发病率为 0.58%（95%置信区间，0.42%至 0.81%）。在 COVID-19 病例中，15 例（42.86%）为重症病例，其中 2 例死亡。PLWH 的 COVID-19 发病率、病例严重程度和病死率与武汉整个人群相当。有 197 名 PLWH 停止了联合抗逆转录病毒治疗（cART），其中 4 名发生了 COVID-19。COVID-19 的危险因素为年龄≥50 岁和 cART 停药。PLWH 中确诊 COVID-19 病例的 SARS-CoV-2 病毒脱落中位持续时间为 30 天（四分位间距，20-46）。高 HIV 病毒载量（≥20 拷贝/ml）的病例的 IgM 和 IgG 水平低于低 HIV 病毒载量（<20 拷贝/ml；IgM 的信号值与临界值之比[S/CO]中位数，分别为 0.03 和 0.11[P<0.001]；IgG 的 S/CO 中位数，分别为 10.16 和 17.04[P=0.069]）。
结论
在 COVID-19 流行期间，需要努力维持对 50 岁或以上老年 PLWH 的持续抗逆转录病毒治疗供应。HIV 和 SARS-CoV-2 的合并感染可能会改变 PLWH 中 COVID-19 患者的病情进展和预后。
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