Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Calle Joaquín Rodrigo 1, Majadahonda 28222, Madrid, Spain.
UNIR Health Sciences School and Medical Center, Calle García Martín 21, Pozuelo de Alarcón 28224, Madrid, Spain.
QJM. 2023 Feb 14;116(1):57-62. doi: 10.1093/qjmed/hcac215.
Underlying immunodeficiency is associated with severe COVID-19, but the prognosis of persons with human immunodeficiency virus (HIV) (PWH) with COVID-19 is under debate. Aim: assessment of the mortality rate and major determinants of death in HIV-infected patients hospitalized with COVID-19 in Spain before vaccine availability. Design: Retrospective nationwide public database analysis.
Nationwide, retrospective, observational analysis of all hospitalizations with COVID-19 during year 2020 in Spain. Stratification was made according to HIV status. The National Registry of Hospital Discharges was used with the ICD-10 coding list.
A total of 117 694 adults were hospitalized with COVID-19 during 2020. Only 234 (0.2%) were HIV-positives. More than 95% were on antiretroviral therapy. Compared to HIV-negatives, PWH were younger (mean age 53.2 vs. 66.5 years old; P<0.001) and more frequently male (74.8% vs. 56.6%; P<0.001). Most co-morbidities predisposing to severe COVID-19 (diabetes, hypertension, dementia and cardiovascular disease) were more frequent in HIV-negatives. In contrast, the rate of baseline liver disease was over 6-fold higher in PWH (27.4% vs. 4.4%; P<0.001). In-hospital mortality was lower in PWH (9.4% vs. 16%; P=0.004). In multivariate analysis, older age, dementia and especially advanced liver disease (relative risk (RR): 7.6) were the major determinants of death in PWH hospitalized with COVID-19.
HIV-infected patients hospitalized in Spain with COVID-19 during 2020 had better survival than HIV-negatives, most likely explained by younger age and lower rate of co-morbidities. However, advanced liver disease was a major predictor of death in PWH hospitalized with COVID-19.
潜在的免疫缺陷与严重的 COVID-19 有关，但人类免疫缺陷病毒 (HIV) 感染者 (PWH) 感染 COVID-19 的预后仍存在争议。目的：评估在疫苗问世之前，西班牙因 COVID-19 住院的 HIV 感染者的死亡率和死亡的主要决定因素。设计：回顾性全国性公共数据库分析。
对 2020 年西班牙所有 COVID-19 住院患者进行全国性、回顾性、观察性分析。根据 HIV 状况进行分层。使用国际疾病分类第 10 次修订版 (ICD-10) 编码列表对国家住院患者数据库进行分析。
2020 年期间，共有 117694 名成年人因 COVID-19 住院。只有 234 例（0.2%）为 HIV 阳性。超过 95%的患者正在接受抗逆转录病毒治疗。与 HIV 阴性患者相比，PWH 更年轻（平均年龄 53.2 岁 vs. 66.5 岁；P<0.001），更常为男性（74.8% vs. 56.6%；P<0.001）。大多数易导致严重 COVID-19 的合并症（糖尿病、高血压、痴呆和心血管疾病）在 HIV 阴性患者中更为常见。相比之下，基线肝病的发生率在 PWH 中高出 6 倍以上（27.4% vs. 4.4%；P<0.001）。PWH 的院内死亡率较低（9.4% vs. 16%；P=0.004）。多变量分析显示，年龄较大、痴呆症，尤其是晚期肝病（相对风险 (RR)：7.6）是 PWH 因 COVID-19 住院死亡的主要决定因素。
2020 年在西班牙因 COVID-19 住院的 HIV 感染者的生存率好于 HIV 阴性患者，这很可能是由于年龄较小和合并症发生率较低所致。然而，晚期肝病是 PWH 因 COVID-19 住院死亡的主要预测因素。
