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与 COVID-19 住院的 HIV 感染者的临床特征和结局:一项全国性经验。

Clinical characteristics and outcomes of people living with HIV hospitalized with COVID-19: a nationwide experience.

机构信息

Department of Infectious Diseases, School of Medicine, 28033Pontificia Universidad Católica de Chile, Santiago, Chile.

Department of Internal Medicine, School of Medicine, 28033Pontificia Universidad Católica de Chile, Santiago, Chile.

出版信息

Int J STD AIDS. 2021 Apr;32(5):435-443. doi: 10.1177/0956462420973106. Epub 2021 Feb 3.

Abstract

In this prospective, multicentric, observational study, we describe the clinical characteristics and outcomes of people living with HIV (PLHIV) requiring hospitalization due to COVID-19 in Chile and compare them with Chilean general population admitted with SARS-CoV-2. Consecutive PLHIV admitted with COVID-19 in 23 hospitals, between 16 April and 23 June 2020, were included. Data of a temporally matched-hospitalized general population were used to compare demography, comorbidities, COVID-19 symptoms, and major outcomes. In total, 36 PLHIV subjects were enrolled; 92% were male and mean age was 44 years. Most patients (83%) were on antiretroviral therapy; mean CD4 count was 557 cells/mm. Suppressed HIV viremia was found in 68% and 56% had, at least, one comorbidity. Severe COVID-19 occurred in 44.4%, intensive care was required in 22.2%, and five patients died (13.9%). No differences were seen between recovered and deceased patients in CD4 count, HIV viral load, or time since HIV diagnosis. Hypertension and cardiovascular disease were associated with a higher risk of death ( = 0.02 and 0.006, respectively). Compared with general population, the HIV cohort had significantly more men (OR 0.15; IC 95% 0.07-0.31) and younger age (OR 8.68; IC 95% 2.66-28.31). In PLHIV, we found more intensive care unit admission (OR 2.31; IC 95% 1.05-5.07) but no differences in the need for mechanical ventilation or death. In this cohort of PLHIV hospitalized with COVID-19, hypertension and cardiovascular comorbidities, but not current HIV viro-immunologic status, were the most important risk factors for mortality. No differences were found between PLHIV and general population in the need for mechanical ventilation and death.

摘要

在这项前瞻性、多中心、观察性研究中,我们描述了因 COVID-19 而需要住院的智利 HIV 感染者(PLHIV)的临床特征和结局,并将其与因 SARS-CoV-2 住院的智利一般人群进行了比较。2020 年 4 月 16 日至 6 月 23 日期间,23 家医院连续收治了因 COVID-19 住院的 PLHIV。我们使用了在时间上相匹配的住院一般人群的数据来比较人口统计学、合并症、COVID-19 症状和主要结局。共纳入 36 例 PLHIV 患者;92%为男性,平均年龄为 44 岁。大多数患者(83%)正在接受抗逆转录病毒治疗;平均 CD4 计数为 557 个细胞/mm。68%的患者 HIV 病毒载量被抑制,56%的患者至少有一种合并症。44.4%的患者发生严重 COVID-19,22.2%的患者需要重症监护,5 名患者死亡(13.9%)。在 CD4 计数、HIV 病毒载量或 HIV 诊断时间方面,未发现恢复和死亡患者之间有差异。高血压和心血管疾病与死亡风险增加相关(=0.02 和 0.006)。与一般人群相比,HIV 队列中男性明显更多(OR 0.15;95%CI 0.07-0.31),年龄更小(OR 8.68;95%CI 2.66-28.31)。在 PLHIV 中,我们发现需要入住重症监护病房的患者更多(OR 2.31;95%CI 1.05-5.07),但需要机械通气或死亡的患者没有差异。在这组因 COVID-19 住院的 PLHIV 中,高血压和心血管合并症,但不是当前的 HIV 病毒免疫状态,是死亡的最重要危险因素。在需要机械通气和死亡方面,PLHIV 与一般人群没有差异。

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