scholarly journals 536. HIV Patients with COVID-19 in the Bronx: A Retrospective Cohort Study

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S335-S336
Author(s):  
Philip J Lee ◽  
Surksha Sirichand ◽  
Nataly Rios Gutierrez ◽  
Luis Gonzalez Corro ◽  
Carlos Cruz ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Viral Load ◽  
Retrospective Review ◽  
Kidney Injury ◽  
The United States ◽  
Secondary Outcome ◽  
People Living With Hiv ◽  
Hiv Viral Load ◽  
Cd4 Counts ◽  
Increased Risk

Abstract Background Since the start of the pandemic there has been limited data on mortality in people living with HIV (PLWH) who have Coronavirus Disease 2019 (COVID-19) in the United States (US). We conducted a retrospective review to investigate potential risk factors associated with survival and need for medical ventilation for PLWH and COVID-19. Methods This is a retrospective observational cohort from a large academic center across three campuses, conducted from January 1, 2020 to April 30, 2020. Thirty day readmissions were observed from January 1, 2020 to May 31, 2020. Our patients were identified by an ICD-10 code (B20) corresponding to HIV and positive SARS-CoV-2 PCR test. As a primary endpoint, we compared survivors vs. non-survivors. As a secondary endpoint, we compared patients who needed mechanical ventilator (MV) vs. those who did not need MV. Results Seventy two PLWH (28 female patients (39%), median [IQR] age was 62 [-/+16] years) had positive SARS-CoV-2 PCR tests during this retrospective review. Median CD4+ count was 235 cells/ul and 11 (15%) had an HIV viral load >200 copies/mL. The median length of stay was 5 days and 6 patients were directly discharged from the emergency department. Ten patients were readmitted within 30 days with SARS-CoV-2 – like symptoms and 2 are still inpatient. Twenty patients (27.8%) have expired. All non-survivors that expired had an undetectable HIV viral load (0%, p=0.02). The 11 patients with unsuppressed HIV viral loads at the start of the study period all survived, p=0.02. Non-survivors were more likely to have chronic kidney disease CKD (p< 0.01) acute kidney injury (p< 0.01), higher absolute neutrophils (p< 0.01), and elevated IL-6 levels (p< 0.01) compared to survivors. Fifteen patients (20.8%) required mechanical ventilation (MV), 3 (4.1%) of those patients survived. Patients that required MV were more likely to be male (p=0.01) obese (p< 0.01) and had higher absolute neutrophil counts (p=0.01) versus those that did not need MV. Patients with lower CD4 counts (< 200 cells/uL) did not require more mechanical ventilation (p=0.04). Table 1: Demographics, Primary and Secondary Outcome Results Conclusion PLWH who had COVID-19 had a high mortality rate. Since all the patients who died had an undetectable HIV viral load across CD4 counts, our study suggests that patients with uncontrolled HIV are not at an increased risk of mortality. Disclosures All Authors: No reported disclosures

scholarly journals COVID-19 infections post-vaccination by HIV status in the United States

2021 ◽  
Author(s):  
Sally B. Coburn ◽  
Elizabeth Humes ◽  
Raynell Lang ◽  
Cameron Stewart ◽  
Brenna C Hogan ◽  
...  
Keyword(s):  
Viral Load ◽  
Cumulative Incidence ◽  
The United States ◽  
Infection Risk ◽  
Hiv Status ◽  
Viral Load Suppression ◽  
Hiv Viral Load ◽  
Post Vaccination ◽  
Increased Risk ◽  
Vaccine Type

ABSTRACTImportanceRecommendations for additional doses of COVID vaccine are restricted to people with HIV who have advanced disease or unsuppressed HIV viral load. Understanding SARS-CoV-2 infection risk post-vaccination among PWH is essential for informing vaccination guidelines.ObjectiveEstimate the risk of breakthrough infections among fully vaccinated people with (PWH) and without (PWoH) HIV in the US.Design, setting, and participantsThe Corona-Infectious-Virus Epidemiology Team (CIVET)-II cohort collaboration consists of 4 longitudinal cohorts from integrated health systems and academic health centers. Each cohort identified individuals ≥18 years old, in-care, and fully vaccinated for COVID-19 through 30 June 2021. PWH were matched to PWoH on date fully vaccinated, age group, race/ethnicity, and sex at birth. Incidence rates per 1,000 person-years and cumulative incidence of breakthrough infections with 95% confidence intervals ([,]) were estimated by HIV status. Cox proportional hazards models estimated adjusted hazard ratios (aHR) of breakthrough infections by HIV status adjusting for demographic factors, prior COVID-19 illness, vaccine type (BNT162b2, [Pfizer], mRNA-1273 [Moderna], Jansen Ad26.COV2.S [J&J]), calendar time, and cohort. Risk factors for breakthroughs among PWH, were also investigated.ExposureHIV infectionOutcomeCOVID-19 breakthrough infections, defined as laboratory evidence of SARS-CoV-2 infection or COVID-19 diagnosis after an individual was fully vaccinated.ResultsAmong 109,599 individuals (31,840 PWH and 77,759 PWoH), the rate of breakthrough infections was higher in PWH versus PWoH: 44 [41, 48] vs. 31 [29, 33] per 1,000 person-years. Cumulative incidence at 210 days after date fully vaccinated was low, albeit higher in PWH versus PWoH overall (2.8% versus 2.1%, log-rank p<0.001, risk difference=0.7% [0.4%, 1.0%]) and within each vaccine type. Breakthrough infection risk was 41% higher in PWH versus PWoH (aHR=1.41 [1.28, 1.56]). Among PWH, younger age (18-24 versus 45-54), history of COVID-19 prior to fully vaccinated date, and J&J vaccination (versus Pfizer) were associated with increased risk of breakthroughs. There was no association of breakthrough with HIV viral load suppression or CD4 count among PWH.Conclusions and RelevanceCOVID-19 vaccination is effective against infection with SARS-CoV-2 strains circulating through 30 Sept 2021. PWH have an increased risk of breakthrough infections compared to PWoH. Recommendations for additional vaccine doses should be expanded to all PWH.

scholarly journals Risk of adverse COVID-19 outcomes for people living with HIV: a rapid review and meta-analysis

2020 ◽  
Author(s):  
Maya Mellor ◽  
Anne Bast ◽  
Nicholas Jones ◽  
Nia Roberts ◽  
Jose Ordonez-Mena ◽  
...  
Keyword(s):  
Viral Load ◽  
T Cell ◽  
Meta Analysis ◽  
Cd4 T Cell ◽  
Rapid Review ◽  
People Living With Hiv ◽  
Hiv Viral Load ◽  
Increased Risk ◽  
Living With Hiv ◽  
Cd4 T Cell Count

Objective: To assess whether people living with HIV (PLWH) are at increased risk of COVID-19 mortality or adverse outcomes, and whether antiretroviral therapy (ART) influences this risk. Design: Rapid review with meta-analysis and narrative synthesis. Methods: We searched databases including Embase, Medline, medRxiv, and Google Scholar up to 26th August 2020 for studies describing COVID-19 outcomes in PLWH and conducted a meta-analysis of higher quality studies. Results: We identified 1,908 studies and included 19 in the review. In a meta-analysis of five studies, PLWH had a higher risk of COVID-19 mortality (hazard ratio (HR) 1.93, 95% Confidence Interval (CI): 1.59-2.34) compared to people without HIV. Risk of death remained elevated for PLWH in a subgroup analysis of hospitalised cohorts (HR 1.54, 95% CI: 1.05-2.24) and studies of PLWH across all settings (HR 2.08, 95%CI: 1.69-2.56). Eight other studies assessed the association between HIV and COVID-19 outcomes, but provided inconclusive, lower-quality evidence due to potential confounding and selection bias. There were insufficient data on the effect of CD4+ T cell count and HIV viral load on COVID-19 outcomes. Eleven studies reported COVID-19 outcomes by ART-regimen. In the two largest studies, tenofovir-disoproxil-fumarate (TDF)-based regimens were associated with a lower risk of adverse COVID-19 outcomes, although these analyses are susceptible to confounding by comorbidities. Conclusion: Evidence is emerging that suggests a moderately increased risk of COVID-19 mortality amongst PLWH. Further investigation into the relationship between COVID-19 outcomes and CD4+ T cell count, HIV viral load, ART and the use of TDF is warranted.

Utility of CD4 Cell Count and Viral Load Assay in Hospitalized Patients with Known HIV Infection: High Value Care Exercise

2020 ◽  
Vol 20 (4) ◽  
pp. 486-490 ◽  
Author(s):  
Amos Lal ◽  
George M. Abraham
Keyword(s):  
Viral Load ◽  
The United States ◽  
Hospitalized Patients ◽  
Hospital Length Of Stay ◽  
Hiv Viral Load ◽  
Cd4 Counts ◽  
Cell Counts ◽  
Viral Load Assay ◽  
The Mean ◽  
Cd4 Cell

Purpose: Healthcare spending as a percentage of Gross domestic product (GDP) is at all-time high and continues to rise in the United States. The Centers for Medicare and Medicaid Services estimate that 33% of resources spent on healthcare goes to waste. As part of a ‘high value care’ exercise, we studied if estimating CD4 cell counts and HIV viral load in hospitalized patients with a known diagnosis of HIV led to any meaningful change in HAART regimen and discharge diagnosis. Methods: Retrospective chart review for all patients admitted with a known diagnosis of HIV from January 1, through December 31, 2017. Results: A total of 83 patient encounters were reviewed during the period. The mean age was 54.1 ± 16.4 years, 64.1 % of patients were males. 75 patients (90.3%) were already on highly active antiretroviral therapy (HAART). The median hospital length of stay (LOS) was 3 days (IQR 2.0 - 5.0). The mean turnaround time for CD4 counts and HIV viral load assay was 2.9 days (95% CI 2.1 – 3.7) and 3.9 days (95% CI, 3.2 – 4.6), respectively. A CD4 count estimation led to no change in HAART regimen. HIV viral load assay testing had no impact on a change in treatment or a change in diagnosis. Conclusions: In our study, testing CD4 counts and HIV viral load for inpatients did not confer any benefit in altering the diagnosis or HAART regimen. We believe that our study identifies a systems level opportunity to add to the concept of ‘Choosing Wisely.’

scholarly journals Descriptive account of 18 adults with known HIV infection hospitalised with SARS-CoV-2 infection

2020 ◽  
pp. sextrans-2020-054660 ◽  
Author(s):  
Sara Madge ◽  
Tristan J Barber ◽  
Alan Hunter ◽  
Sanjay Bhagani ◽  
Marc Lipman ◽  
...  
Keyword(s):  
Clinical Course ◽  
People Living With Hiv ◽  
Immune Restoration ◽  
Hiv Viral Load ◽  
Cd4 Counts ◽  
Frequent Contact ◽  
Descriptive Account ◽  
Increased Risk ◽  
Almost All ◽  
Living With Hiv

ObjectiveTo report on the clinical characteristics and outcome of 18 people living with HIV (PLWH) hospitalised with SARS-CoV-2 infection in a London teaching hospital.MethodsThe hospital notes of 18 PLWH hospitalised with SARS-CoV-2 infection were retrospectively reviewed alongside data concerning their HIV demographics from an established HIV Database.ResultsThe majority (16/18) had positive PCR swabs for SARS-CoV-2, and two had negative swabs but typical COVID-19 imaging and history. Most were male (14/18, 78%), median age 63 years (range 47–77 years). Two-thirds were migrants, nine (50%) of Black, Asian and minority ethnicity (BAME). All were diagnosed with HIV for many years (range 8–31 years), and all had an undetectable HIV viral load (<40 copies/mL). The median CD4 prior to admission was 439 (IQR 239–651), and 10/16 (63%) had a CD4 nadir below 200 cells/mm3. Almost all (17/18) had been diagnosed with at least one comorbidity associated with SARS-CoV-2 prior to admission. 3/18 patients died. None received mechanical ventilation. Hospital stay and clinical course did not appear prolonged (median 9 days).ConclusionsOur data suggest that PLWH may not necessarily have prolonged or complex admissions to hospital when compared with the general hospital and national population admitted with COVID-19. Many had low nadir CD4 counts and potentially impaired functional immune restoration. The PLWH group was younger than generally reported for COVID-19, and the majority were male with multiple complex comorbidities. These patients had frequent contact with hospital settings increasing potential for nosocomial acquisition and increased risk of severe COVID-19.

scholarly journals Increased Prevalence of Liver Fibrosis and HIV Viremia among Patients with HIV, HBV, and Tuberculosis in Botswana

Pathogens ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. 950
Author(s):  
Bonolo B. Phinius ◽  
Motswedi Anderson ◽  
Lynnette Bhebhe ◽  
Kabo Baruti ◽  
Godiraone Manowe ◽  
...  
Keyword(s):  
Viral Load ◽  
Liver Fibrosis ◽  
People Living With Hiv ◽  
Hiv Viral Load ◽  
Art Initiation ◽  
Increased Risk ◽  
Significant Difference ◽  
B Virus ◽  
Apri Score ◽  
Living With Hiv

People with concomitant human immunodeficiency virus (HIV) and tuberculosis (TB) have an increased risk of hepatotoxic reactions due to antiretroviral therapy (ART) and anti-TB therapy (ATT). Concomitant hepatitis B virus (HBV) in these patients may lead to poorer health outcomes. To assess liver enzyme levels and immune response in adults with HIV, HBV, and TB, data from 300 antiretroviral-naïve people living with HIV (PLWHIV) were analyzed. The prevalence of HIV/HBV (cHIV/HBV) and HIV/TB (cHIV/TB) was 28% (95% CI: 23.0–33.4) and 10% (95% CI: 6.8–14.0), respectively. HIV/HBV/TB (cHIV/HBV/TB) prevalence was 5.3% (95% CI: 3.1–8.5). There was a statistically significant difference between the groups of participants in HIV viral load (p = 0.004), hemoglobin levels (p = 0.025), and body mass index (p = 0.011). A larger proportion of cHIV/HBV/TB participants (37.5%) had an aspartate aminotransferase to platelet ratio index (APRI) score ≥0.5 (p = 0.013), a lower cutoff for significant liver fibrosis. Immunological non-responders (CD4+ T-cell count <20% gain and HIV viral load <400 copies/mL at 6 months) were observed in all groups except those with cHIV/TB. Our findings support the need to screen for infections that could cause excessive liver damage prior to ATT or ART initiation, such as HBV.

scholarly journals The complex relationship between CD4 count, HIV viral load, trimethoprim-sulfamethoxazole prophylaxis, and skin-and-soft-tissue infection risk in patients with HIV: insights from a causal diagram and simulation study

2016 ◽  
Vol 144 (13) ◽  
pp. 2889-2898 ◽  
Author(s):  
V. HEMMIGE ◽  
D. S. LAUDERDALE ◽  
M. Z. DAVID
Keyword(s):  
Staphylococcus Aureus ◽  
Viral Load ◽  
Soft Tissue ◽  
Soft Tissue Infection ◽  
The United States ◽  
Tissue Infection ◽  
Hiv Viral Load ◽  
Causal Diagram ◽  
Increased Risk ◽  
Immunological Factors

SUMMARYSkin and soft tissue infection (SSTIs) due to Staphylococcus aureus, particularly community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA), are common in human immunodeficiency virus (HIV)-infected populations in the United States. Studies have differed as to the importance of epidemiological and immunological factors in this relationship, and have employed conflicting strategies for variable selection in multivariate analyses. Developments in causal inference methods in epidemiology have emerged in the last decade to clarify relationships between variables and identify appropriate variables to include in and exclude from multivariate analysis. In this paper, we develop a causal diagram to clarify the pathways linking CA-MRSA and HIV. We focus on the role played by trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis, prescribed to many severely immunocompromised HIV patients and potentially protective against SSTIs, which both mediates and moderates the relationship between immunological parameters and SSTI risk. We demonstrate, using simulated data, that statistical models may yield biased results if they do not account for how HIV viral load may also be a marker of adherence to TMP-SMX prophylaxis. We conclude with a proposed causal model that includes both the epidemiological as well as immunological factors that may explain the increased risk of initial and recurrent SSTI risk in HIV-infected populations.

scholarly journals Clinical characteristics and outcomes of people living with HIV hospitalized with COVID-19: a nationwide experience

2021 ◽  
Vol 32 (5) ◽  
pp. 435-443
Author(s):  
Maria Elena Ceballos ◽  
Patricio Ross ◽  
Martin Lasso ◽  
Isabel Dominguez ◽  
Marcela Puente ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
General Population ◽  
Clinical Characteristics ◽  
Cd4 Count ◽  
People Living With Hiv ◽  
Hiv Diagnosis ◽  
Hiv Viral Load ◽  
Risk Of Death ◽  
Living With Hiv

In this prospective, multicentric, observational study, we describe the clinical characteristics and outcomes of people living with HIV (PLHIV) requiring hospitalization due to COVID-19 in Chile and compare them with Chilean general population admitted with SARS-CoV-2. Consecutive PLHIV admitted with COVID-19 in 23 hospitals, between 16 April and 23 June 2020, were included. Data of a temporally matched-hospitalized general population were used to compare demography, comorbidities, COVID-19 symptoms, and major outcomes. In total, 36 PLHIV subjects were enrolled; 92% were male and mean age was 44 years. Most patients (83%) were on antiretroviral therapy; mean CD4 count was 557 cells/mm3. Suppressed HIV viremia was found in 68% and 56% had, at least, one comorbidity. Severe COVID-19 occurred in 44.4%, intensive care was required in 22.2%, and five patients died (13.9%). No differences were seen between recovered and deceased patients in CD4 count, HIV viral load, or time since HIV diagnosis. Hypertension and cardiovascular disease were associated with a higher risk of death ( p = 0.02 and 0.006, respectively). Compared with general population, the HIV cohort had significantly more men (OR 0.15; IC 95% 0.07–0.31) and younger age (OR 8.68; IC 95% 2.66–28.31). In PLHIV, we found more intensive care unit admission (OR 2.31; IC 95% 1.05–5.07) but no differences in the need for mechanical ventilation or death. In this cohort of PLHIV hospitalized with COVID-19, hypertension and cardiovascular comorbidities, but not current HIV viro-immunologic status, were the most important risk factors for mortality. No differences were found between PLHIV and general population in the need for mechanical ventilation and death.

scholarly journals Predictors of virological failure among people living with HIV receiving first line antiretroviral treatment in Myanmar: retrospective cohort analysis

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Anita Mesic ◽  
Alexander Spina ◽  
Htay Thet Mar ◽  
Phone Thit ◽  
Tom Decroo ◽  
...  
Keyword(s):  
Viral Load ◽  
Virological Failure ◽  
Antiretroviral Treatment ◽  
People Living With Hiv ◽  
First Line ◽  
Hiv Viral Load ◽  
Loss To Follow Up ◽  
History Of ◽  
Living With Hiv

Abstract Background Progress toward the global target for 95% virological suppression among those on antiretroviral treatment (ART) is still suboptimal. We describe the viral load (VL) cascade, the incidence of virological failure and associated risk factors among people living with HIV receiving first-line ART in an HIV cohort in Myanmar treated by the Médecins Sans Frontières in collaboration with the Ministry of Health and Sports Myanmar. Methods We conducted a retrospective cohort study, including adult patients with at least one HIV viral load test result and having received of at least 6 months’ standard first-line ART. The incidence rate of virological failure (HIV viral load ≥ 1000 copies/mL) was calculated. Multivariable Cox’s regression was performed to identify risk factors for virological failure. Results We included 25,260 patients with a median age of 33.1 years (interquartile range, IQR 28.0–39.1) and a median observation time of 5.4 years (IQR 3.7–7.9). Virological failure was documented in 3,579 (14.2%) participants, resulting in an overall incidence rate for failure of 2.5 per 100 person-years of follow-up. Among those who had a follow-up viral load result, 1,258 (57.1%) had confirmed virological failure, of which 836 (66.5%) were switched to second-line treatment. An increased hazard for failure was associated with age ≤ 19 years (adjusted hazard ratio, aHR 1.51; 95% confidence intervals, CI 1.20–1.89; p < 0.001), baseline tuberculosis (aHR 1.39; 95% CI 1.14–1.49; p < 0.001), a history of low-level viremia (aHR 1.60; 95% CI 1.42–1.81; p < 0.001), or a history of loss-to-follow-up (aHR 1.24; 95% CI 1.41–1.52; p = 0.041) and being on the same regimen (aHR 1.37; 95% CI 1.07–1.76; p < 0.001). Cumulative appointment delay was not significantly associated with failure after controlling for covariates. Conclusions VL monitoring is an important tool to improve programme outcomes, however limited coverage of VL testing and acting on test results hampers its full potential. In our cohort children and adolescents, PLHIV with history of loss-to-follow-up or those with low-viremia are at the highest risk of virological failure and might require more frequent virological monitoring than is currently recommended.

P5341Predictive factors of atherosclerotic cardiovascular diseases events in HIV-HVC co-infected patients: results from hepavih ANRS co13 cohort

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
F Boccara ◽  
B K Tan ◽  
M Chalouni ◽  
D Salmon Ceron ◽  
A Cinaud ◽  
...  
Keyword(s):  
Viral Load ◽  
Sustained Viral Response ◽  
Biological Data ◽  
Personal History ◽  
Hiv Viral Load ◽  
Factors Associated ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
History Of

Abstract Introduction Several studies highlighted an increased risk of cardiovascular disease (CVD) in HIV-HCV co-infected patients without clearly identifying specific virologic factors associated with atherosclerotic CVD (ASCVD) events. Purpose Hence, we analyzed data collection from the French nationwide ANRS CO13 HEPAVIH cohort to determine the incidence of ASCVD events in HIV-HCV co-infected patients and the predictive factors associated with its occurrence. Methods The French multicenter nationwide ANRS CO13 HEPAVIH clinic-based cohort collected prospective clinical and biological data from HIV-HCV co-infected patients followed-up in 28 different university hospitals between December 2005 to November 2016. Participants with at least one year of follow-up were included. Primary outcome was the occurrence of major ASCVD events (cardiovascular death, acute coronary syndrome, coronary revascularization and stroke). Secondary outcomes were total ASCVD events including major ASCVD events and minor ASCVD events (peripheral arterial disease [PAD]). Incidence rates were estimated using Aalen-Johansen method and factors associated with ASCVD identified with Cox proportional hazards models. Results A total of 1213 patients were included: median age 45.4 years [42.1–49.0], 70.3% men, current smoking 70.2%, overweight 19.5%, liver cirrhosis 18.9%, chronic alcohol consumption 7.8%, diabetes mellitus (5.9%), personal history of CVD 2.7%, and statins use 4.1%. After a median follow-up of 5.1 years [3.9–7.0], 44 participants experienced at least one ASCVD event (26 major ASCVD event, and 20 a minor event). Incidences for total, major and minor ASCVD events were of 6.98 [5.19; 9.38], 4.01 [2.78; 6.00], and 3.17 [2.05; 4.92] per 1000 person-years, respectively. Personal history of CVD (Hazard Ratio (HR)=13.94 [4.25–45.66]), high total cholesterol (HR=1.63 [1.24–2.15]), low HDL cholesterol (HR=0.08 [0.02–0.34]) and undetectable HIV viral load (HR=0.41 [0.18–0.96]) were identified as independent factors associated with major ASCVD events while cirrhosis status, liver fibrosis and HCV sustained viral response were not. Cumulative incidence of CV events Conclusion HIV-HCV co-infected patients experience a high incidence of ASCVD events both coronary and peripheral artery diseases. Traditional CV risk factors are the main determinants of ASCVD whereas undetectable HIV viral load seems to be protective. Management of cholesterol abnormalities and controlling viral load are essential to modify this high cardiovascular risk. Acknowledgement/Funding Agence Natoinale de Recherche sur le SIDA et les Hépatites virales

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