key: cord-0011876-6x5a1rqb
authors: Childs, Kate; Post, Frank A; Norcross, Claire; Ottaway, Zoë; Hamlyn, Elizabeth; Quinn, Killian; Juniper, Thomas; Taylor, Chris
title: Hospitalized Patients With COVID-19 and Human Immunodeficiency Virus: A Case Series
date: 2020-05-27
journal: Clin Infect Dis
DOI: 10.1093/cid/ciaa657
sha: 73d0e4e7273262a361aac91ae9fed3f8fa76fdcd
doc_id: 11876
cord_uid: 6x5a1rqb

nan

To the Editor-We read with interest the article by Gervasoni et al, which describes a series of 47 people with human immunodeficiency virus (PWH) and confirmed or suspected coronavirus disease 2019 (COVID-19), 45 (96%) of whom made a full recovery [1] . Thirteen (28%) were hospitalized, 2 required ventilation, and 1 died. They conclude that the risk of severe COVID-19 in PWH was no greater, and perhaps slightly lower, than that reported in the general population. Of note, and similar to an earlier report by Blanco et al [2] , ethnicity data were not reported, although emerging data in the general population suggest that race and ethnicity are associated with clinical outcomes in COVID-19 infection [3] .

King's College Hospital in South London, United Kingdom, serves an ethnically diverse population and was affected early and severely by the COVID-19 pandemic [4] . We report the clinical characteristics of 18 PWH who were hospitalized with confirmed COVID-19 (ie, RNA positive for severe acute respiratory syndrome coronavirus 2) including the proportion who reached a composite endpoint of death, requiring mechanical ventilation or intensive treatment unit admission. We also compared the characteristics of those hospitalized with COVID-19 to our general human immunodeficiency virus (HIV) outpatient population.

The median age of our PWH and COVID-19 was 52 years, and most (94%) were black males with longstanding HIV infection and on antiretroviral therapy (ART) with undetectable HIV viral loads ( Table 1 ). The majority were obese though none were smokers. The median duration of COVID-19 symptoms at admission was 8 days (interquartile range, 7-10 days). Two patients developed COVID-19 as inpatients, likely as a result of nosocomial transmission. The commonest presenting symptoms were fever, shortness of breath, and cough. Most (78%) had bilateral chest radiograph changes consistent with viral pneumonitis and required oxygen therapy. Two patients were treated with remdesivir [5] , and in 2 patients ART was switched to lopinavir/ritonavir [6] . Seven patients (39%) reached the composite endpoint; these patients had similar HIV and demographic characteristics compared to those who did not reach this endpoint. At the time of writing, 5 patients had died (median time from admission to death, 8 days [range, 3-28 days]), 12 patients were successfully discharged from hospital (median duration of hospitalization, 9 days [range, 6- Table 1 ). There was a trend toward more common use of protease inhibitor-containing antiretroviral regimens among those with COVID-19 (OR, 2.43 [95% CI, .94-6.29]).

Our data indicate that, in contrast to earlier reports [1, 2] , there may be substantial morbidity and mortality from COVID-19 among PWH, even among those on suppressive ART. Black PWH appear to be at substantially increased risk of severe disease, and darunavir (or any other class of ART) does not appear to provide protection against moderate/ severe COVID-19. If confirmed, African regions with a high prevalence of HIV infection may be particularly vulnerable to the impact of the COVID-19 pandemic.

Supplementary materials are available at Clinical Infectious Diseases online. Consisting of data provided by the authors to benefit the reader, the posted materials are not copyedited and are the sole responsibility of the authors, so questions or comments should be addressed to the corresponding author.

Author contributions. The study was designed by K. C. and F. A. P.; K. C., C. N., Z. O., E. H., K. Q., and T. J. provided clinical care and data for the analysis. K. C., C. N., and F. A. P. performed the analyses. K. C. and F. A. P. wrote the first draft of the manuscript. All authors revised and approved the final version of the manuscript.

Acknowledgments. The authors thank Lucy Campbell for assistance with the analysis presented in Supplementary Table 1 .

Potential conflicts of interest. F. A. P. reports grants and/or personal fees from Gilead Sciences, ViiV, Janssen, and MSD. All other authors report no potential conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. 

Clinical features and outcomes of HIV patients with coronavirus disease

COVID-19 in HIV Investigators. COVID-19 in patients with HIV: clinical case series

Are some ethnic groups more vulnerable to COVID-19 than others? Available at: www.nuffieldfoundation.org. Accessed 1

COVID-19 diagnoses in south east London peaked before the UK suggesting early measures reduced transmission

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