一项关于人类免疫缺陷病毒和 2019 冠状病毒病患者的多中心注册研究的特征、合并症和结局。

Characteristics, Comorbidities, and Outcomes in a Multicenter Registry of Patients With Human Immunodeficiency Virus and Coronavirus Disease 2019.

机构信息

Division of Infectious Diseases, University of Missouri-Columbia, Columbia, Missouri, USA.

School of Medicine, University of Missouri-Columbia, Columbia, Missouri, USA.

出版信息

Clin Infect Dis. 2021 Oct 5;73(7):e1964-e1972. doi: 10.1093/cid/ciaa1339.

DOI:10.1093/cid/ciaa1339

PMID:32905581

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7499544/

Abstract

BACKGROUND

People living with human immunodeficiency virus (HIV) may have numerous risk factors for acquiring coronavirus disease 2019 (COVID-19) and developing severe outcomes, but current data are conflicting.

METHODS

Health-care providers enrolled consecutively, by nonrandom sampling, people living with HIV (PWH) with lab-confirmed COVID-19, diagnosed at their facilities between 1 April and 1 July 2020. Deidentified data were entered into an electronic Research Electronic Data Capture (REDCap) system. The primary endpoint was a severe outcome, defined as a composite endpoint of intensive care unit (ICU) admission, mechanical ventilation, or death. The secondary outcome was the need for hospitalization.

RESULTS

There were 286 patients included; the mean age was 51.4 years (standard deviation, 14.4), 25.9% were female, and 75.4% were African American or Hispanic. Most patients (94.3%) were on antiretroviral therapy, 88.7% had HIV virologic suppression, and 80.8% had comorbidities. Within 30 days of testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), 164 (57.3%) patients were hospitalized, and 47 (16.5%) required ICU admission. Mortality rates were 9.4% (27/286) overall, 16.5% (27/164) among those hospitalized, and 51.5% (24/47) among those admitted to an ICU. The primary composite endpoint occurred in 17.5% (50/286) of all patients and 30.5% (50/164) of hospitalized patients. Older age, chronic lung disease, and hypertension were associated with severe outcomes. A lower CD4 count (<200 cells/mm3) was associated with the primary and secondary endpoints. There were no associations between the ART regimen or lack of viral suppression and the predefined outcomes.

CONCLUSIONS

Severe clinical outcomes occurred commonly in PWH with COVID-19. The risks for poor outcomes were higher in those with comorbidities and lower CD4 cell counts, despite HIV viral suppression.

CLINICAL TRIALS REGISTRATION

NCT04333953.

摘要

背景

感染人类免疫缺陷病毒（HIV）的人群可能存在多种感染 2019 年冠状病毒病（COVID-19）和出现重症的风险因素，但目前的数据存在矛盾。

方法

通过非随机抽样，医疗保健提供者连续纳入了在其机构于 2020 年 4 月 1 日至 7 月 1 日期间确诊的 HIV 感染者（PLWH）合并实验室确诊 COVID-19 的患者。将匿名数据输入电子 Research Electronic Data Capture（REDCap）系统。主要终点是重症，定义为 ICU 入住、机械通气或死亡的复合终点。次要终点是住院的需求。

结果

共纳入 286 例患者；平均年龄为 51.4 岁（标准差为 14.4），25.9%为女性，75.4%为非裔美国人或西班牙裔。大多数患者（94.3%）正在接受抗逆转录病毒治疗，88.7%的 HIV 病毒学得到抑制，80.8%存在合并症。在 SARS-CoV-2 检测呈阳性后的 30 天内，164 例（57.3%）患者住院，47 例（16.5%）需要 ICU 入住。总体死亡率为 9.4%（27/286），住院患者为 16.5%（27/164），ICU 入住患者为 51.5%（24/47）。主要复合终点发生在所有患者的 17.5%（50/286）、住院患者的 30.5%（50/164）。年龄较大、慢性肺部疾病和高血压与重症结局相关。CD4 计数较低（<200 个细胞/mm3）与主要和次要终点相关。ART 方案或病毒抑制缺乏与预定结局之间无关联。