Faiz Zohaa, Quazi Mohammed A, Vahil Neel, Barrows Charles M, Ikram Hafiz Abdullah, Nasrullah Adeel, Farooq Asif, Gangu Karthik, Sheikh Abu Baker
Department of Medicine, School of Medicine, Aga Khan University, Karachi 74000, Pakistan.
Department of Mathematics and Statistics, University of New Mexico, Albuquerque, NM 87106, USA.
Biomedicines. 2023 Jul 5;11(7):1904. doi: 10.3390/biomedicines11071904.
The concurrence of HIV and COVID-19 yields unique challenges and considerations for healthcare providers, patients living with HIV, and healthcare systems at-large. Persons living with HIV may face a higher risk of acquiring SARS-CoV-2 infection and experiencing worse clinical outcomes compared to those without. Notably, COVID-19 may have a disproportionate impact on historically disadvantaged populations, including African Americans and those stratified in a lower socio-economic status. Using the National Inpatient Sample (NIS) database, we compared patients with a diagnosis of both HIV and COVID-19 and those who exclusively had a diagnosis of COVID-19. The primary outcome was in-hospital mortality. Secondary outcomes were intubation rate and vasopressor use; acute MI, acute kidney injury (AKI); AKI requiring hemodialysis (HD); venous thromboembolism (VTE); septic shock and cardiac arrest; length of stay; financial burden on healthcare; and resource utilization. A total of 1,572,815 patients were included in this study; a COVID-19-positive sample that did not have HIV ( = 1,564,875, 99.4%) and another sample with HIV and COVID-19 ( = 7940, 0.56%). Patients with COVID-19 and HIV did not have a significant difference in mortality compared to COVID-19 alone (10.2% vs. 11.3%, respectively, = 0.35); however, that patient cohort did have a significantly higher rate of AKI (33.6% vs. 28.6%, aOR: 1.26 [95% CI 1.13-1.41], < 0.001). Given the complex interplay between HIV and COVID-19, more prospective studies investigating the factors such as the contribution of viral burden, CD4 cell count, and the details of patients' anti-retroviral therapeutic regimens should be pursued.
艾滋病毒（HIV）与2019冠状病毒病（COVID-19）并存给医疗服务提供者、HIV感染者以及整个医疗系统带来了独特的挑战和需要考虑的问题。与未感染HIV的人相比，HIV感染者感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的风险可能更高，临床结局也可能更差。值得注意的是，COVID-19可能对包括非裔美国人以及社会经济地位较低人群在内的历史上处于不利地位的人群产生不成比例的影响。我们使用全国住院患者样本（NIS）数据库，比较了同时诊断为HIV和COVID-19的患者与仅诊断为COVID-19的患者。主要结局是住院死亡率。次要结局包括插管率和血管活性药物使用情况；急性心肌梗死、急性肾损伤（AKI）；需要血液透析（HD）的AKI；静脉血栓栓塞（VTE）；感染性休克和心脏骤停；住院时间；医疗保健的经济负担；以及资源利用情况。本研究共纳入1572815名患者；一个未感染HIV的COVID-19阳性样本（n = 1564875，99.4%）和另一个同时感染HIV和COVID-19的样本（n = 7940，0.56%）。与仅感染COVID-19的患者相比，同时感染COVID-19和HIV的患者在死亡率方面没有显著差异（分别为10.2%和11.3%，P = 0.35）；然而，该患者队列的AKI发生率显著更高（33.6%对28.6%，调整后比值比：1.26 [95%置信区间1.13 - 1.41]，P < 0.001）。鉴于HIV与COVID-19之间复杂的相互作用，应开展更多前瞻性研究，调查病毒载量、CD4细胞计数以及患者抗逆转录病毒治疗方案细节等因素。
