New York University Langone Transplant Institute, New York, NY.
Department of Medicine/Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY.
Transplantation. 2021 Jan 1;105(1):216-224. doi: 10.1097/TP.0000000000003527.
Transplant recipients with HIV may have worse outcomes with coronavirus disease 2019 (COVID-19) due to impaired T-cell function coupled with immunosuppressive drugs. Alternatively, immunosuppression might reduce inflammatory complications and/or antiretrovirals could be protective.
Prospective reporting of all cases of SARS-CoV-2 infection was required within the HOPE in Action Multicenter Consortium, a cohort of kidney and liver transplant recipients with HIV who have received organs from donors with and without HIV at 32 transplant centers in the United States.
Between March 20, 2020 and September 25, 2020, there were 11 COVID-19 cases among 291 kidney and liver recipients with HIV (4%). In those with COVID-19, median age was 59 y, 10 were male, 8 were kidney recipients, and 5 had donors with HIV. A higher proportion of recipients with COVID-19 compared with the overall HOPE in the Action cohort were Hispanic (55% versus 12%) and received transplants in New York City (73% versus 34%, P < 0.05). Most (10/11, 91%) were hospitalized. High-level oxygen support was required in 7 and intensive care in 5; 1 participant opted for palliative care instead of transfer to the intensive care unit. HIV RNA was undetectable in all. Median absolute lymphocyte count was 0.3 × 103 cells/μL. Median CD4 pre-COVID-19 was 298 cells/μL, declining to <200 cells/μl in 6/7 with measurements on admission. Treatment included high-dose steroids (n = 6), tocilizumab (n = 3), remdesivir (n = 2), and convalescent plasma (n = 2). Four patients (36%) died.
Within a national prospective cohort of kidney and liver transplant recipients with HIV, we report high mortality from COVID-19.
由于 T 细胞功能受损以及免疫抑制药物的作用，感染 HIV 的移植受者在 2019 年冠状病毒病（COVID-19）方面可能会出现更差的结果。或者，免疫抑制可能会减轻炎症并发症，和/或抗逆转录病毒可能具有保护作用。
需要在美国 32 个移植中心的 HOPE in Action 多中心联盟内对所有 SARS-CoV-2 感染病例进行前瞻性报告，该联盟由接受过来自 HIV 阳性和 HIV 阴性供体的器官的 HIV 阳性肾和肝移植受者组成。
在 2020 年 3 月 20 日至 2020 年 9 月 25 日之间，在 291 名 HIV 阳性肾和肝移植受者中，有 11 例 COVID-19 病例（4％）。在患有 COVID-19 的患者中，中位年龄为 59 岁，10 名男性，8 名肾移植受者，5 名供者 HIV 阳性。与 HOPE in Action 队列中的其他患者相比，COVID-19 患者中更多的是西班牙裔（55％比 12％），并且在纽约市接受移植（73％比 34％，P <0.05）。大多数（10/11，91％）住院。7 人需要高流量氧气支持，5 人需要重症监护；1 名患者选择姑息治疗而不是转入重症监护病房。所有患者的 HIV RNA 均无法检测到。中位绝对淋巴细胞计数为 0.3×103 个细胞/μL。COVID-19 前中位 CD4 细胞计数为 298 个细胞/μL，7 例中有 6 例在入院时降至<200 个细胞/μL。治疗包括高剂量类固醇（n = 6），托珠单抗（n = 3），瑞德西韦（n = 2）和恢复期血浆（n = 2）。有 4 名患者（36％）死亡。
在一项针对 HIV 阳性肾和肝移植受者的全国前瞻性队列研究中，我们报告 COVID-19 死亡率很高。
