Department of Surgery, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md., USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md., USA; Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa.
S Afr Med J. 2024 Apr 24;114(3b):e1374. doi: 10.7196/SAMJ.2024.v114i3b.1374.
HIV-infected kidney transplant recipients with COVID-19 are at increased risk of acute illness and death owing to their underlying comorbidities and chronic immunosuppression.
To describe the incidence, clinical presentation and course of COVID-19, vaccination status, and SARS-CoV-2 antibody positivity rate among HIV-infected-to-HIV-infected kidney transplant recipients in South Africa (SA).
This retrospective study reports on rates of SARS-CoV-2 infection, COVID-19 and mortality among SA HIV-infected kidney transplant recipients who received organs from HIV-infected donors (HIV positive to HIV positive), before and after vaccination. Patient demographics, clinical presentation, course, management and disease outcomes were analysed. Antibody serology tests were performed between May and September 2022.
Among 39 HIV-positive-to-HIV-positive transplant recipients, 11 cases of COVID-19 were diagnosed from March 2020 to September 2022. Six patients (55%) required hospitalisation, of whom 3 were admitted to a high-care unit or intensive care unit. Two patients required mechanical ventilation, and 2 received acute dialysis. One patient was declined access to intensive care. Four patients (10%) died of COVID-19 pneumonia. All the COVID-19-positive patients had at least one comorbidity. Vaccination data were available for 24 patients, of whom 5 had refused SARS-CoV-2 vaccination. SARS-CoV-2 antibody data were available for 20 patients; 4 vaccinated patients had a negative nucleocapsid protein antibody test and a positive spike protein antibody test, suggesting vaccination-acquired immunity. The remaining 16 patients demonstrated immunity that was probably due to COVID infection, and of these, 14 were also vaccinated. Of the 11 COVID-19 cases, only 1 was observed after vaccination.
In our case series, ~10% of the HIV-positive-to-HIV-positive transplant recipients died of COVID-19 pneumonia. This mortality rate appears higher than figures reported in other transplant cohorts. However, it is likely that the actual number of cases of SARS-CoV-2 infection was much higher, as the study only included polymerase chain reaction-confirmed cases. It remains unclear whether HIV infection, transplant or the combination of the two drives poorer outcomes, and larger studies adjusting for important demographic and biological factors may isolate these effects.
由于合并症和慢性免疫抑制，感染 HIV 的肾移植受者因 COVID-19 而急性发病和死亡的风险增加。
描述南非（SA）感染 HIV 的肾移植受者中 HIV 感染的供体到 HIV 感染的受者（HIV 阳性到 HIV 阳性）之间 COVID-19 的发生率、临床表现和病程、疫苗接种情况以及 SARS-CoV-2 抗体阳性率。
这项回顾性研究报告了在接种疫苗前后，SA 感染 HIV 的肾移植受者中 SARS-CoV-2 感染、COVID-19 和死亡率的发生率。分析了患者的人口统计学、临床表现、病程、管理和疾病结局。在 2022 年 5 月至 9 月期间进行了抗体血清学检测。
在 39 例 HIV 阳性到 HIV 阳性的移植受者中，从 2020 年 3 月至 2022 年 9 月诊断出 11 例 COVID-19。6 例患者（55%）需要住院治疗，其中 3 例患者被收治于重症监护病房或 ICU。2 例患者需要机械通气，2 例患者接受急性透析。1 例患者被拒绝进入 ICU。4 例患者（10%）死于 COVID-19 肺炎。所有 COVID-19 阳性患者均至少有 1 种合并症。有 24 例患者提供了疫苗接种数据，其中 5 例患者拒绝接种 SARS-CoV-2 疫苗。有 20 例患者提供了 SARS-CoV-2 抗体数据；4 例接种疫苗的患者核衣壳蛋白抗体检测阴性，刺突蛋白抗体检测阳性，提示接种获得免疫。其余 16 例患者的免疫可能是由于 COVID 感染所致，其中 14 例也接种了疫苗。在 11 例 COVID-19 病例中，只有 1 例是在接种疫苗后观察到的。
在我们的病例系列中，约 10%的 HIV 阳性到 HIV 阳性的移植受者死于 COVID-19 肺炎。这一死亡率似乎高于其他移植队列报告的死亡率。然而，由于研究仅包括聚合酶链反应确诊的病例，因此实际的 SARS-CoV-2 感染病例数可能更高。目前尚不清楚是 HIV 感染、移植还是两者的结合导致了更差的结果，并且可能需要更大的研究来调整重要的人口统计学和生物学因素以分离这些影响。
