TreatmentUpdate
238

November 2020 

Comparisons between hospitalized people in the UK

A study called ISARIC compared health-related information from HIV-positive and HIV-negative people, all of whom were hospitalized due to COVID-19. Researchers with ISARIC found that, in general, HIV-positive people tended to be younger, were more likely to be obese, and had higher levels of inflammation and more symptoms of COVID-19 than HIV-negative people. Overall, HIV-positive people hospitalized with COVID-19 had a 47% increased risk of death compared to HIV-negative people who were also hospitalized for COVID-19.

Comparisons

Researchers analysed information collected between January and June 2020. For the current analysis they used data from 47,592 HIV-negative people and 122 HIV-positive people, 112 of whom had a record of using HIV treatment (ART). Only one person was diagnosed with HIV upon admission to hospital. Generally, HIV-positive people were younger than HIV-negative people (56 vs. 74 years old) and had fewer comorbidities. Black people were over-represented among HIV-positive people who were hospitalized due to COVID-19—45% vs. about 26% of all HIV-positive people in the UK.

  • As with the overall HIV epidemic in the UK, there were more men in the HIV-positive group.
  • HIV-negative people were more likely to have two or more co-morbidities.
  • HIV-positive people tended to have higher rates of obesity and moderate/severe liver disease.

Symptoms

HIV-positive people were more likely to have the following symptoms upon hospitalization:

  • fever
  • headache
  • cough
  • muscle pain
  • higher-than-normal heart rate
  • chest pain

Lab tests revealed that HIV-positive people were more likely to have lower total white blood cell and platelet counts but higher lymphocyte levels. The amount of C-reactive protein (CRP; indicative of inflammation) was greater in HIV-positive people than in HIV-negative people.

Critical care and survival

The chance of being admitted to a critical care unit was similar for both populations.

28 days after a diagnosis of COVID-19

Overall, 28 days after a diagnosis of COVID-19, 27% of HIV-positive people died vs. 32% of HIV-negative people. However, when researchers adjusted their analyses by age, they found a significant difference in the distribution of deaths in people under the age of 60, as follows:

  • HIV-positive people – 21%
  • HIV-negative people – 10%

This difference was statistically significant.

The reason(s) for these findings regarding age and survival in ISARIC is unclear.

The researchers found that HIV-positive people who died were slightly older and more likely to have diabetes and obesity than HIV-positive people who survived. Furthermore, it appears that in ISARIC, HIV-positive people who died were less likely to have a record of ART use.

Bear in mind

In ISARIC, HIV-positive people had fewer comorbidities than HIV-negative people. Researchers suspect that this difference arose because HIV-positive people were significantly younger than HIV-negative people.

Although diabetes and obesity were linked to an increased risk of death in HIV-positive people, researchers suspect that there may be other, as yet unidentified, underlying issues that played a role in their demise.

ISARIC’s strength is that it was directly able to compare data from HIV-positive and HIV-negative people and take into account many factors, including age, gender, and so on. However, ISARIC also had weaknesses that seem to bedevil many published studies of HIV-positive people with COVID-19. It lacked comprehensive immunological and virological data related to HIV as well as data about the use of ART. ISARIC was also missing data about socio-economic status. This lack of data on different issues is due to the difficulty of conducting research in the midst of a pandemic caused by a novel virus that has had a tremendously disruptive impact on health systems and societies. Many hospitals in the UK and elsewhere were over-burdened with sick and dying patients and many hospital staff likely were exhausted during the time that data were collected.

In the meantime, the ISARIC team offered the following advice for healthcare providers who are caring for people with HIV or who are at high risk for HIV:

  • Diagnose HIV early.
  • If diagnosed with HIV, offer ART promptly.
  • Engage in optimized screening for and control of comorbidities, including obesity and diabetes.

—Sean R. Hosein

REFERENCE:

Geretti AM, Stockdale AJ, Kelly SH, et al. Outcomes of COVID-19 related hospitalization among people with HIV in the ISARIC WHO Clinical Characterization Protocol (UK): a prospective observational study. Clinical Infectious Diseases. 2020; in press.