Victor Babes Clinical Hospital for Infectious and Tropical Diseases, Bucharest, Romania.
Carol Davila University for Medicine and Pharmacy, Bucharest, Romania.
HIV Med. 2024 Mar;25(3):343-352. doi: 10.1111/hiv.13578. Epub 2023 Nov 28.
To date there remains much ambiguity in the literature regarding the immunological interplay between SARS-CoV-2 and HIV and the true risk posed to coinfected individuals. There has been little conclusive data regarding the use of CD4 cell count and HIV viral load stratification as predictors of COVID-19 severity in this cohort.
We performed a retrospective, observational cohort study on people living with HIV (PLWH) who contracted COVID-19 in central and eastern Europe. We enrolled 536 patients from 16 countries using an online survey. We evaluated patient demographics, HIV characteristics and COVID-19 presentation and outcomes. Statistical analysis was performed using SPSS 20.1.
The majority of the study cohort were male (76.4%) and 152 (28.3%) had a significant medical comorbidity. Median CD4 cell count at COVID-19 diagnosis was 605 cells/μL [interquartile range (IQR) 409-824]. The majority of patients on antiretroviral therapy (ART) were virally suppressed (92%). In univariate analysis, CD4 cell count <350 cells/μL was associated with higher rates of hospitalization (p < 0.0001) and respiratory failure (p < 0.0001). Univariate and multivariate analyses found that an undetectable HIV VL was associated with a lower rate of hospitalization (p < 0.0001), respiratory failure (p < 0.0001), ICU admission or death (p < 0.0001), and with a higher chance of full recovery (p < 0.0001).
We can conclude that detectable HIV viral load was an independent risk factor for severe COVID-19 illness and can be used as a prognostic indicator in this cohort.
迄今为止，关于 SARS-CoV-2 和 HIV 之间的免疫学相互作用以及合并感染个体所面临的真正风险，文献中仍存在很多歧义。关于 CD4 细胞计数和 HIV 病毒载量分层作为该队列中 COVID-19 严重程度预测因子的应用，几乎没有确凿的数据。
我们对在中欧和东欧感染 COVID-19 的艾滋病毒感染者（PLWH）进行了回顾性观察队列研究。我们使用在线调查从 16 个国家招募了 536 名患者。我们评估了患者的人口统计学特征、HIV 特征以及 COVID-19 的表现和结局。使用 SPSS 20.1 进行统计分析。
研究队列中的大多数患者为男性（76.4%），152 人（28.3%）有显著的合并症。COVID-19 诊断时的中位 CD4 细胞计数为 605 个/μL [四分位距（IQR）409-824]。大多数接受抗逆转录病毒治疗（ART）的患者病毒得到抑制（92%）。在单因素分析中，CD4 细胞计数<350 个/μL 与更高的住院率（p<0.0001）和呼吸衰竭率（p<0.0001）相关。单因素和多因素分析发现，不可检测的 HIV VL 与较低的住院率（p<0.0001）、呼吸衰竭率（p<0.0001）、重症监护病房（ICU）入院或死亡率（p<0.0001）以及完全康复的几率较高（p<0.0001）相关。
我们可以得出结论，可检测的 HIV 病毒载量是 COVID-19 严重疾病的独立危险因素，可以作为该队列的预后指标。
