Influence of HIV infection on clinical course of the new coronavirus infection (COVID-19)

Abstract

BACKGROUND: Human immunodeficiency virus (HIV)-associated severe immunosuppression, high viral load, non-HIV-related comorbidities and conditions, and lack of antiretroviral therapy may exacerbate the clinical course of coronavirus disease 2019 (COVID-19).

AIM: To assess the effect of HIV infection on the clinical course of COVID-19, disease severity, and its outcomes.

MATERIALS AND METHODS: Medical records of 35,328 patients who had COVID-19 in 2020 were analyzed, including 46 cases of COVID-19 in individuals with HIV infection. Clinical variants and COVID-19 severity, frequency of COVID-19 detection by polymerase chain reaction, CD4 lymphocyte count, viral load in individuals with HIV infection, and mortality rates were assessed.

RESULTS: In 76% of patients with coinfection, signs of HIV infection progression, opportunistic infections, and concomitant diseases were noted. Moreover, 52.2% of the patients analyzed were users of psychoactive substances. Among patients with HIV and COVID-19, men predominated in groups aged >30 years, whereas among the HIV-negative population, women were predominant in groups aged >18 years. The proportion of severe COVID-19 in individuals with HIV infection (47.8%) exceeds that in the group without HIV (12.3%). The mortality rate from COVID-19 in the HIV-infected group was more than seven times higher than that in the HIV-negative group (t=1.81; p=0.01).

CONCLUSIONS: In the HIV-infected group, extremely severe COVID-19 was more common. Weakness, cough, shortness of breath, and myalgia were significantly more common in the HIV-infected group. Moreover, the HIV-infected group with an undetectable viral load and adequate CD4 lymphocyte count in the blood was exposed to the same risks of the disease and its progression as the HIV-negative group.

Keywords

COVID-19 / coronavirus / SARS-CoV-2 / HIV / antiretroviral drugs / viral load / psychoactive substances

References

[1] Kanwugu ON, Adadi P. HIV/SARS-CoV-2 coinfection: A global perspective. J Med Virol. 2021;93(2):726–732. doi: 10.1002/jmv.26321

[2] Kanwugu O.N., Adadi P. HIV/SARS-CoV-2 coinfection: A global perspective // J Med Virol. 2021. Vol. 93, N 2. P. 726–732. doi: 10.1002/jmv.26321

[3] Blanco JL, Ambrosioni J, Garcia F, et al.; COVID-19 in HIV Investigators. COVID-19 in patients with HIV: clinical case series. Lancet HIV. 2020;7(5):e314–e316. doi: 10.1016/S2352-3018(20)30111-9

[4] Blanco J.L., Ambrosioni J., Garcia F., et al.; COVID-19 in HIV Investigators. COVID-19 in patients with HIV: clinical case series // Lancet HIV. 2020. Vol. 7, N 5. P. e314–e316. doi: 10.1016/S2352-3018(20)30111-9

[5] Ladnaya NN, Kozyrina NV, Babikhina KA, et al. Results of the study “Studying the prevalence of coronavirus infection COVID-19 among HIV-infected patients in Russia and the impact of the epidemic of coronavirus infection COVID-19 on the provision of medical care for HIV infection. Moscow: Central Research Institute of Epidemiology; 2020. 71 p. (In Russ).

[6] Ладная Н.Н., Козырина Н.В., Бабихина К.А., и др. Результаты исследования «Изучение распространенности коронавирусной инфекции COVID-19 среди инфицированных ВИЧ пациентов в России и влияния эпидемии коронавирусной инфекции COVID-19 на оказание медицинской помощи при ВИЧ-инфекции». Москва: ЦНИИ эпидемиологии, 2020. 71 с.

[7] Yezhlova EB, Demina YuV, Igonina EP, et al. Epidemiology and prevention of COVID-19: guidelines MP 3.1.0170-20. Moscow; 2020. 20 p. (In Russ).

[8] Ежлова Е.Б., Демина Ю.В., Игонина Е.П., и др. Эпидемиология и профилактика COVID-19: методические рекомендации МР 3.1.0170-20. Москва, 2020. 20 с.

[9] UNAIDS data 2019. Available from: https://www.unaids.org/sites/default/files/media_asset/2019-UNAIDS-data_en.pdf Accessed: Dec 16, 2022.

[10] UNAIDS data 2019. Режим доступа: https://www.unaids.org/sites/default/files/media_asset/2019-UNAIDS-data_en.pdf Дата обращения: 16.12.2022

[11] Shiau S, Krause KD, Valera P, et al. The Burden of COVID-19 in People Living with HIV: A Syndemic Perspective. AIDS Behav. 2020;24(8):2244–2249. doi: 10.1007/s10461-020-02871-9

[12] Shiau S., Krause K.D., Valera P., et al. The Burden of COVID-19 in People Living with HIV: A Syndemic Perspective // AIDS Behav. 2020. Vol. 24, N 8. P. 2244–2249. doi: 10.1007/s10461-020-02871-9

[13] Questions and answers: HIV and coronavirus (COVID-19) [Voprosy i otvety: VICH i koronavirus (COVID-19)]. Available from: https://life4me.plus/ru/covid-19/ Accessed: Dec 16, 2022.

[14] Вопросы и ответы: ВИЧ и коронавирус (COVID-19). Режим доступа: https://life4me.plus/ru/covid-19/ Дата обращения: 16.12.2022

[15] Coronavirus disease (COVID-19). Situation Report — 163. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200701-covid-19-sitrep-163.pdf Accessed: Dec 16, 2022.

[16] Coronavirus disease (COVID-19). Situation Report — 163. Режим доступа: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200701-covid-19-sitrep-163.pdf Дата обращения: 16.12.2022

[17] Avdeev SN, Adamyan LV, Alekseeva EI, et al. Prevention, Diagnosis, and Treatment of Novel Coronavirus Infection (COVID-19): Interim Guidelines. Version 9 (10/26/2020). Moscow; 2020. 236 p. (In Russ).

[18] Авдеев С.Н., Адамян Л.В., Алексеева Е.И. и др. Профилактика, диагностика и лечение новой коронавирусной инфекции (COVID-19): временные методические рекомендации. Версия 9 (26.10.2020). Москва, 2020. 236 с.

[19] Hoffmann C, Casado JL, Härter G, et al. Immune deficiency is a risk factor for severe COVID-19 in people living with HIV. HIV Med. 2021;22(5):372–378. doi: 10.1111/hiv.13037

[20] Hoffmann C., Casado J.L., Härter G., et al. Immune deficiency is a risk factor for severe COVID-19 in people living with HIV // HIV Med. 2021. Vol. 22, N 5. P. 372–378. doi: 10.1111/hiv.13037

[21] Byrd KM, Beckwith CG, Garland JM, et al. SARS-CoV-2 and HIV coinfection: clinical experience from Rhode Island, United States. J Int AIDS Soc. 2020;23(7):e25573. doi: 10.1002/jia2.25573

[22] Byrd K.M., Beckwith C.G., Garland J.M., et al. SARS-CoV-2 and HIV coinfection: clinical experience from Rhode Island, United States // J Int AIDS Soc. 2020. Vol. 23, N 7. P. e25573. doi: 10.1002/jia2.25573

[23] BHIVA, DAIG, EACS, GESIDA, Polish Scientific AIDS Society and Portuguese Association for the clinical study of AIDS (APECS). Statement on risk of COVID-19 for people living with HIV (PLWH) and SARS-CoV-2 vaccine advice for adults living with HIV. Available from: https://www.bhiva.org/joint-statement-on-risk-of-COVID-19-for-PLWH-and-SARS-CoV-2-vaccine-advice Accessed: Dec 16, 2022.

[24] BHIVA, DAIG, EACS, GESIDA, Polish Scientific AIDS Society and Portuguese Association for the clinical study of AIDS (APECS). Statement on risk of COVID-19 for people living with HIV (PLWH) and SARS-CoV-2 vaccine advice for adults living with HIV. Режим доступа: https://www.bhiva.org/joint-statement-on-risk-of-COVID-19-for-PLWH-and-SARS-CoV-2-vaccine-advice Дата обращения: 16.12.2022

[25] Docherty AB, Harrison EM, Green CA, et al.; ISARIC4C investigators. Features of 20 133 UK patients in hospital with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ. 2020;369:m1985. doi: 10.1136/bmj.m1985

[26] Docherty A.B., Harrison E.M., Green C.A., et al.; ISARIC4C investigators. Features of 20 133 UK patients in hospital with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study // BMJ. 2020. Vol. 369. P. m1985. doi: 10.1136/bmj.m1985

[27] Gusev DА, Vashukova МА, Feduniak IP, et al. Experience with the use of recombinant humanized monoclonal antibodies to the human receptor for interleukin-6 in patients with CoVID-19. Journal Infectology. 2020;12(3):28–33. (In Russ). doi: 10.22625/2072-6732-2020-12-3-28-33

[28] Гусев Д.А., Вашукова М.А., Федуняк И.П., и др. Опыт применения рекомбинантного гуманизированного моноклонального антитела к человеческому рецептору интерлейкина-6 у пациентов с COVID-19 // Журнал инфектологии. 2020. Т. 12, № 3. С. 28–33. doi: 10.22625/2072-6732-2020-12-3-28-33

[29] Malinnikova EYu. New coronaviral infection. Today’s look at the pandemic of the XXI century. Infectious Diseases: News, Opinions, Training. 2020;9(2):18–32. (In Russ). doi: 10.33029/2305-3496-2020-9-2-18-32

[30] Малинникова Е.Ю. Новая коронавирусная инфекция. Сегодняшний взгляд на пандемию XXI века // Инфекционные болезни: новости, мнения, обучение. 2020. Т. 9, № 2. С. 18–32. doi: 10.33029/2305-3496-2020-9-2-18-32

[31] Ruzhentsova TA, Chukhliaev PV, Khavkina DA., et al. Potential for etiotropic therapy of SARSCoV-2-induced coronavirus disease in outpatients. Medical Opponent. 2020;(1):48–58. (In Russ).

[32] Руженцова Т.А., Чухляев П.В., Хавкина Д.А., и др. Возможности этиотропной терапии коронавирусной инфекции, вызванной SARS-CoV-2, у амбулаторных пациентов // Медицинский оппонент. 2020. № 1. С. 48–58.

[33] Coronavirus Disease 2019 (COVID-19). Treatment Guidelines. Available from: https://www.covid19treatmentguidelines.nih.gov/ Accessed: Dec 16, 2022.

[34] Coronavirus Disease 2019 (COVID-19). Treatment Guidelines. Режим доступа: https://www.covid19treatmentguidelines.nih.gov/ Дата обращения: 16.12.2022

[35] Therapeutics and COVID-19: living guideline. Treatment Guidelines. Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV-therapeutics-2022.4 Accessed: Dec 16, 2022.

[36] Therapeutics and COVID-19: living guideline. Режим доступа: https://www.who.int/publications/i/item/WHO-2019-nCoV-therapeutics-2022.4 Дата обращения: 16.12.2022

[37] Bagnenko SF, Belyakov NA, Rassokhin VV, et al. The beginning of the COVID-19 epidemic. Saint Petersburg: Baltic Medical Education Center; 2020. 360 p. (In Russ).

[38] Багненко С.Ф., Беляков Н.А., Рассохин В.В., и др. Начало эпидемии COVID-19. Санкт-Петербург: Балтийский медицинский образовательный центр, 2020. 360 с.

[39] Stepanova EV, Leonova ON, Shelomov AS, Vinogradova TN. Coronavirus infection in patients with HIV infection, features of the course. Journal Infectology. 2021;13(2):61–69. (In Russ). doi: 10.22625/2072-6732-2021-13-2-61-69

[40] Степанова Е.В., Леонова О.Н., Шеломов А.С., Виноградова Т.Н. Новая коронавирусная инфекция (COVID-19) у больных с ВИЧ-инфекцией // Журнал инфектологии. 2021. Т. 13, № 2. С. 61–69. doi: 10.22625/2072-6732-2021-13-2-61-69

[41] Carrico AW, Horvath KJ, Grov C, et al. Double Jeopardy: Methamphetamine Use and HIV as Risk Factors for COVID-19. AIDS Behav. 2020;24(11):3020–3023. doi: 10.1007/s10461-020-02854-w

[42] Carrico A.W., Horvath K.J., Grov C., et al. Double Jeopardy: Methamphetamine Use and HIV as Risk Factors for COVID-19 // AIDS Behav. 2020. Vol. 24, N 11. P. 3020–3023. doi: 10.1007/s10461-020-02854-w

[43] Shcherba YuV. A systematic approach to infectious and non-infectious lesions of the respiratory system during the illegal use of narcotic drugs and psychotropic substances. Zhurnal infektsionnoi patologii. 2004;(3-4):117–121. (In Russ).

[44] Щерба Ю.В. Систематический подход к инфекционным и неинфекционным поражениям системы органов дыхания при незаконном употреблении наркотических средств и психотропных веществ // Журнал инфекционной патологии. 2004. № 3-4. С. 117–121.

[45] Benson MK, Bentley AM. Lung disease induced by drug addiction. Thorax. 1995;50(11):1125–1127. doi: 10.1136/thx.50.11.1125

[46] Benson M.K., Bentley A.M. Lung disease induced by drug addiction // Thorax. 1995. Vol. 50, N 11. P. 1125–1127. doi: 10.1136/thx.50.11.1125

[47] Wolff AJ, O’Donnell AE. Pulmonary effects of illicit drug use. Clin Chest Med. 2004;25(1):203–216. doi: 10.1016/S0272-5231(03)00137-0

[48] Wolff A.J., O’Donnell A.E. Pulmonary effects of illicit drug use // Clin Chest Med. 2004. Vol. 25, N 1. P. 203–216. doi: 10.1016/S0272-5231(03)00137-0

[49] Traclet J, Khouatra C, Piégay F, et al. Pulmonary arterial hypertension in heroin users. J Heart Lung Transplant. 2016; 35(7):932–934. doi: 10.1016/j.healun.2016.03.019

[50] Traclet J., Khouatra C., Piégay F., et al. Pulmonary arterial hypertension in heroin users // J Heart Lung Transplant. 2016. Vol. 35, N 7. P. 932–934. doi: 10.1016/j.healun.2016.03.019

[51] Li EA, Koren SV. COVID-19 pandemic and drug users. Problems of Narcology. 2020;(6):72–83. (In Russ). doi: 10.47877/0234-0623_2020_6_72

[52] Ли Е.А., Корень С.В. Пандемия COVID-19 и потребители наркотиков // Вопросы наркологии. 2020. № 6. С. 72–83. doi: 10.47877/0234-0623_2020_6_72

[53] Voytsekhovskiy VV, Korzhova NV, Goborov ND, et al. Lung damage in patients with narcotic dependence. Bulletin physiology and pathology of respiration. 2018;(68):79–91. (In Russ). doi: 10.12737/article_5b19d77f5e9a60.82681424

[54] Войцеховский В.В., Коржова Н.В., Гоборов Н.Д., и др. Поражение легких у больных с наркотической зависимостью // Бюллетень физиологии и патологии дыхания. 2018. № 68. С. 79–91. doi: 10.12737/article_5b19d77f5e9a60.82681424

[55] Akasaki Y, Ohishi M. Cerebrovascular and cardiovascular diseases caused by drugs of abuse. Hypertens Res. 2020;43(5): 363–371. doi: 10.1038/s41440-019-0367-7

[56] Akasaki Y., Ohishi M. Cerebrovascular and cardiovascular diseases caused by drugs of abuse // Hypertens Res. 2020. Vol. 43, N 5. P. 363–371. doi: 10.1038/s41440-019-0367-7

[57] Zhao SX, Kwong C, Swaminathan A, et al. Clinical Characteristics and Outcome of Methamphetamine-Associated Pulmonary Arterial Hypertension and Dilated Cardiomyopathy. JACC Heart Fail. 2018; 6(3):209–218. doi: 10.1016/j.jchf.2017.10.006

[58] Zhao S.X., Kwong C., Swaminathan A., et al. Clinical Characteristics and Outcome of Methamphetamine-Associated Pulmonary Arterial Hypertension and Dilated Cardiomyopathy // JACC Heart Fail. 2018. Vol. 6, N 3. P. 209–218. doi: 10.1016/j.jchf.2017.10.006

[59] Ben-Yehuda O, Siecke N. Crystal Methamphetamine: A Drug and Cardiovascular Epidemic. JACC Heart Fail. 2018;6(3):219–221. doi: 10.1016/j.jchf.2018.01.004

[60] Ben-Yehuda O., Siecke N. Crystal Methamphetamine: A Drug and Cardiovascular Epidemic // JACC Heart Fail. 2018. Vol. 6, N 3. P. 219–221. doi: 10.1016/j.jchf.2018.01.004

[61] Dong Y, Mo X, Hu Y, et al. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics. 2020;145(6):e20200702. doi: 10.1542/peds.2020-0702

[62] Dong Y., Mo X., Hu Y., et al. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China // Pediatrics. 2020. Vol. 145, N 6. P. e20200702. doi: 10.1542/peds.2020-0702

[63] Epidemiology Working Group for NCIP Epidemic Response, Chinese Center for Disease Control and Prevention. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China. Zhonghua Liu Xing Bing Xue Za Zhi. 2020;41(2):145–151. (In Chinese). doi: 10.3760/cma.j.issn.0254-6450.2020.02.003

[64] Epidemiology Working Group for NCIP Epidemic Response, Chinese Center for Disease Control and Prevention. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China // Zhonghua Liu Xing Bing Xue Za Zhi. 2020. Vol. 41, N 2. P. 145–151. (In Chinese). doi: 10.3760/cma.j.issn.0254-6450.2020.02.003

[65] Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061–1069. doi: 10.1001/jama.2020.1585. Erratum in: JAMA. 2021;325(11):1113.

[66] Wang D., Hu B., Hu C., et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China // JAMA. 2020. Vol. 323, N 11. P. 1061–1069. doi: 10.1001/jama.2020.1585. Erratum in: JAMA. 2021. Vol. 325, N 11. P. 1113.

[67] Bhaskaran K, Rentsch CT, MacKenna B, et al. HIV infection and COVID-19 death: a population-based cohort analysis of UK primary care data and linked national death registrations within the OpenSAFELY platform. Lancet HIV. 2021;8(1):e24–e32. doi: 10.1016/S2352-3018(20)30305-2

[68] Bhaskaran K., Rentsch C.T., MacKenna B., et al. HIV infection and COVID-19 death: a population-based cohort analysis of UK primary care data and linked national death registrations within the OpenSAFELY platform // Lancet HIV. 2021. Vol. 8, N 1. P. e24–e32. doi: 10.1016/S2352-3018(20)30305-2

[69] Briko NI, Kagramanyan IN, Nikiforov VV, et al. Pandemic COVID-19. Prevention Measures in the Russian Federation. Epidemiology and Vaccinal Prevention. 2020;19(2):4–12. (In Russ). doi: 10.31631/2073-3046-2020-19-2-4-12

[70] Брико Н.И., Каграманян И.Н., Никифоров В.В., и др. Пандемия COVID-19. Меры борьбы с ее распространением в Российской Федерации // Эпидемиология и вакцинопрофилактика. 2020. Т. 19, № 2. С. 4–12. doi: 10.31631/2073-3046-2020-19-2-4-12

[71] Härter G, Spinner CD, Roider J, et al. COVID-19 in people living with human immunodeficiency virus: a case series of 33 patients. Infection. 2020;48(5):681–686. doi: 10.1007/s15010-020-01438-z

[72] Härter G., Spinner C.D., Roider J., et al. COVID-19 in people living with human immunodeficiency virus: a case series of 33 patients // Infection. 2020. Vol. 48, N 5. P. 681–686. doi: 10.1007/s15010-020-01438-z

[73] Cohen J. 17th Conference on Retroviruses and Opportunistic Infections, 16–19 February, San Francisco, CA. Treatment as prevention. Science. 2010;327(5970):1196–1197. doi: 10.1126/science.327.5970.1196-b. Erratum in: Science. 2010; 328(5981):974.

[74] Cohen J. 17th Conference on Retroviruses and Opportunistic Infections, 16–19 February, San Francisco, CA. Treatment as prevention // Science. 2010. Vol. 327, N 5970. P. 1196–1197. doi: 10.1126/science.327.5970.1196-b. Erratum in: Science. 2010. Vol. 328, N 5981. P. 974.

[75] Smetanina SV, Isaev AN, Isaeva YuO, et al. Change in anti-Sars-CoV-2 igg antibodies (COVID-19) among the population of the Russian Federation regions and in convalescents in dynamics. Consilium Medicum. 2020;22(11):47–50. (In Russ). doi: 10.26442/20751753.2020.11.200417

[76] Сметанина С.В., Исаев А.Н., Исаева Ю.О., и др. Изменение уровня антител класса IgG к коронавирусу SARS-CoV-2 (COVID-19) у населения регионов Российской Федерации и в динамике у реконвалесцентов // Consilium Medicum. 2020. Т. 22, № 11. С. 47–50. DOI: 10.26442/20751753.2020.11.200417

[77] Woloshin S, Patel N, Kesselheim AS. False Negative Tests for SARS-CoV-2 Infection – Challenges and Implications. N Engl J Med. 2020;383(6):e38. doi: 10.1056/NEJMp2015897

[78] Woloshin S., Patel N., Kesselheim A.S. False Negative Tests for SARS-CoV-2 Infection – Challenges and Implications // N Engl J Med. 2020. Vol. 383, N 6. P. e38. doi: 10.1056/NEJMp2015897

[79] Grasping Reality by Brad DeLong. Sample: Immunity to Covid-19 could be lost in months, Uk Study Suggests. Available from: https://www.bradford-delong.com/2020/07/this-may-be-really-really-bad-news-if-this-now-endemic-virus-as-dangerous-and-debilitating-as-it-is-is-also-such-that-som.html. Accessed: Dec 16, 2022.

[80] Grasping Reality by Brad DeLong. Sample: Immunity to Covid-19 could be lost in months, Uk Study Suggests. Режим доступа: https://www.bradford-delong.com/2020/07/this-may-be-really-really-bad-news-if-this-now-endemic-virus-as-dangerous-and-debilitating-as-it-is-is-also-such-that-som.html. Дата обращения: 16.12.2022.

[81] Platonova TA, Golubkova AA, Karbovnichaya EA, Smirnova SS. Features of the Formation of Humoral Immunity in Individuals with Various Clinical Manifestations of COVID-19. Epidemiology and Vaccinal Prevention. 2021;20(1):20–25. (In Russ). doi: 10.31631/2073-3046-2021-20-1-20-25

[82] Платонова Т.А., Голубкова А.А., Карбовничая Е.А., Смирнова С.С. Особенности формирования гуморального иммунитета у лиц с различными клиническими проявлениями COVID-19 // Эпидемиология и вакцинопрофилактика. 2021. Т. 20, № 1. С. 20–25. doi: 10.31631/2073-3046-2021-20-1-20-25

[83] Rijkers G, Murk JL, Wintermans B, et al. Differences in Antibody Kinetics and Functionality Between Severe and Mild Severe Acute Respiratory Syndrome Coronavirus 2 Infections. J Infect Dis. 2020; 222(8):1265–1269. doi: 10.1093/infdis/jiaa463

[84] Rijkers G., Murk J.L., Wintermans B., et al. Differences in Antibody Kinetics and Functionality Between Severe and Mild Severe Acute Respiratory Syndrome Coronavirus 2 Infections // J Infect Dis. 2020. Vol. 222, N 8. P. 1265–1269. doi: 10.1093/infdis/jiaa463

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