Department of Medicine, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Osler 508, Baltimore, MD, 21287, USA.
Critical Care Medicine Department, National Institutes of Health, Bethesa, USA.
AIDS Res Ther. 2022 Feb 11;19(1):6. doi: 10.1186/s12981-022-00430-x.
In hospitalized people with HIV (PWH) there is an increased risk of mortality from COVID-19 among hospitalized PWH as compared to HIV-negative individuals. Evidence suggests that tocilizumab-a humanized monoclonal interleukin (IL)-6 receptor inhibitor (IL-6ri) antibody-has a modest mortality benefit when combined with corticosteroids in select hospitalized COVID-19 patients who are severely ill. Data on clinical outcomes after tocilizumab use in PWH with severe COVID-19 are lacking.
We present a multinational case series of 18 PWH with COVID-19 who were treated with IL-6ri's during the period from April to June 2020. Four patients received tocilizumab, six sarilumab, and eight received an undocumented IL-6ri. Of the 18 patients in the series, 4 (22%) had CD4 counts < 200 cells/mm; 14 (82%) had a suppressed HIV viral load. Eight patients (44%), all admitted to ICU, were treated for secondary infection; 5 had a confirmed organism. Of the four patients with CD4 counts < 200 cells/mm, three were treated for secondary infection, with 2 confirmed organisms. Overall outcomes were poor-12 patients (67%) were admitted to the ICU, 11 (61%) required mechanical ventilation, and 7 (39%) died.
In this case series of hospitalized PWH with COVID-19 and given IL-6ri prior to the common use of corticosteroids, there are reports of secondary or co-infection in severely ill patients. Comprehensive studies in PWH, particularly with CD4 counts < 200 cells, are warranted to assess infectious and other outcomes after IL-6ri use, particularly in the context of co-administered corticosteroids.
与 HIV 阴性个体相比，住院 HIV 感染者（PWH）因 COVID-19 而死亡的风险更高。有证据表明，托珠单抗（一种人源化单克隆白细胞介素 [IL]-6 受体抑制剂 [IL-6ri] 抗体）与皮质类固醇联合使用，对病情严重的 COVID-19 住院患者的死亡率有适度益处。关于托珠单抗治疗严重 COVID-19 的 PWH 的临床结局的数据尚缺乏。
我们报告了 18 例 COVID-19 合并 PWH 的多国家病例系列，这些患者在 2020 年 4 月至 6 月期间接受了 IL-6ri 治疗。4 例患者接受了托珠单抗治疗，6 例患者接受了沙利鲁单抗治疗，8 例患者接受了未记录的 IL-6ri 治疗。在该系列的 18 例患者中，有 4 例（22%）的 CD4 计数 < 200 个细胞/mm；14 例（82%）的 HIV 病毒载量受到抑制。8 例患者（44%），全部收住 ICU，接受继发性感染治疗；5 例患者确诊有感染源。在 CD4 计数 < 200 个细胞/mm 的 4 例患者中，有 3 例因继发性感染接受治疗，其中 2 例有确诊感染源。总体预后较差——12 例患者（67%）收住 ICU，11 例（61%）需要机械通气，7 例（39%）死亡。
在这项针对 COVID-19 合并 PWH 并在常规使用皮质类固醇之前接受 IL-6ri 治疗的住院患者的病例系列研究中，有报道称严重感染患者存在继发性或合并感染。需要在 PWH 中进行全面研究，特别是在 CD4 计数 < 200 个细胞的情况下，评估使用 IL-6ri 后的感染和其他结局，特别是在联合使用皮质类固醇的情况下。
