Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Departamento de Infectología, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico.
BMC Infect Dis. 2024 May 24;24(1):524. doi: 10.1186/s12879-024-09208-0.
While existing research on people living with HIV (PWH) during the COVID-19 pandemic primarily focused on their clinical outcomes, a critical gap remains in understanding the implications of COVID-19 delivery of in-hospital care services to PWH. Our study aimed to describe the characteristics and outcomes of PWH hospitalised during 2020 in Mexico City, comparing patients admitted due to COVID-19 vs. patients admitted due to other causes.
All PWH hospitalised for ≥ 24 h at four institutions in Mexico City from January 1st to December 31st, 2020 were included. Patients were classified into two groups according to the leading cause of their first hospitalisation: COVID-19 or non-COVID-19. Characteristics among groups were compared using chi-square and Kruskal tests. A Cox model was used to describe the risk of death after hospitalisation and the characteristics associated with this outcome. Mortality and hospitalisation events were compared to data from 2019.
Overall, we included 238 PWH hospitalised in 2020. Among them, 42 (18%) were hospitalised due to COVID-19 and 196 (82%) due to non-COVID-19 causes, mainly AIDS-defining events (ADE). PWH hospitalised due to COVID-19 had higher CD4 + cell counts (380 cells/mm3 [IQR: 184-580] vs. 97 cells/mm3 [IQR: 34-272], p < 0.01) and a higher proportion of virologic suppression (VS) compared to those hospitalised due to non-COVID-19 causes (92% vs. 55%, p < 0.01). The adjusted hazard ratio (aHR) for AIDS was 3.1 (95%CI: 1.3-7.2). COVID-19 was not associated with death (aHR 0.9 [95%CI: 0.3-2.9]). Compared to 2019, mortality was significantly higher in 2020 (19% vs. 9%, p < 0.01), while hospitalisations decreased by 57%.
PWH with COVID-19 had higher VS and CD4 + cell counts and lower mortality compared to those hospitalised due to non-COVID-19-related causes, who more often were recently diagnosed with HIV and had ADEs. Most hospitalisations and deaths in 2020 in PWH were related to advanced HIV disease. The increased mortality and decreased hospitalisations of PWH during 2020 evidence the impact of the interruption of health services delivery for PWH with advanced disease due to the pandemic. Our findings highlight the challenges faced by PWH during 2020 in a country where advanced HIV remains a concern.
尽管现有研究主要关注 COVID-19 大流行期间艾滋病毒感染者（PLHIV）的临床结局，但对于 COVID-19 对 PLHIV 住院治疗服务的影响仍存在重要的认识差距。我们的研究旨在描述 2020 年在墨西哥城住院的 PLHIV 的特征和结局，比较因 COVID-19 住院的患者与因其他原因住院的患者。
纳入 2020 年 1 月 1 日至 12 月 31 日在墨西哥城四家机构住院治疗≥24 小时的所有 PLHIV。根据首次住院的主要原因，将患者分为两组：COVID-19 或非 COVID-19。使用卡方检验和克鲁斯卡尔检验比较组间特征。使用 Cox 模型描述住院后的死亡风险和与该结局相关的特征。将死亡率和住院率与 2019 年的数据进行比较。
共纳入 2020 年住院的 238 名 PLHIV。其中，42 名（18%）因 COVID-19 住院，196 名（82%）因非 COVID-19 原因住院，主要是艾滋病定义性事件（ADE）。因 COVID-19 住院的 PLHIV 的 CD4+细胞计数更高（380 个细胞/mm3 [IQR：184-580] 比 97 个细胞/mm3 [IQR：34-272]，p<0.01），且病毒学抑制率（VS）比例更高（92%比 55%，p<0.01），与因非 COVID-19 原因住院的患者相比。艾滋病的调整后危险比（aHR）为 3.1（95%CI：1.3-7.2）。COVID-19 与死亡无关（aHR 0.9 [95%CI：0.3-2.9]）。与 2019 年相比，2020 年死亡率显著升高（19%比 9%，p<0.01），而住院率下降了 57%。
与因非 COVID-19 相关原因住院的患者相比，因 COVID-19 住院的 PLHIV 的 VS 和 CD4+细胞计数更高，死亡率更低，后者通常最近被诊断为 HIV 并患有 ADE。2020 年 PLHIV 住院和死亡的大多数与晚期 HIV 疾病有关。2020 年 PLHIV 死亡率升高和住院率下降证明了大流行期间因晚期疾病中断 PLHIV 健康服务提供的影响。我们的研究结果强调了 2020 年在一个晚期 HIV 仍然是一个问题的国家中 PLHIV 面临的挑战。
