key: cord-1039058-u2s0jc38 authors: Isernia, Valentina; Julia, Zelie; Le Gac, Sylvie; Bachelard, Antoine; Landman, Roland; Lariven, Sylvie; Joly, Véronique; Deconinck, Laurène; Rioux, Christophe; Lescure, Xavier; Yazdanpanah, Yazdan; Ghosn, Jade title: SARS-COV2 infection in 30 HIV-infected patients followed-up in a French University Hospital date: 2020-09-26 journal: Int J Infect Dis DOI: 10.1016/j.ijid.2020.09.1436 sha: 22ab416e8f178ca4095217124dace8352e2940ef doc_id: 1039058 cord_uid: u2s0jc38 INTRODUCTION: An acute respiratory disease caused by a novel coronavirus (SARSCOV2) is spreading from China since January 2020. Surprisingly, few cases of Covid- 19 have been reported in people living with HIV (PLWHIV). METHODS: Here we present a series of 30 PLWHIV diagnosed for SARS-COV2 infection. The principal outcome was to describe clinical characteristics of this population. RESULTS: Eighteen (60%) patients were men, 10/30 (33,3%) women and 2/30 (6,7%) transgender women. Median age was 53,7 years (range 30-80 years) and 23/30 patients (76,7%) were born in a foreign country (out of France). The most common comorbidities were cardiovascular disease (11/30, 36,7%), hypertension (11/30, 36,7%), diabetes (9/30,30%) obesity (7/30, 23%) and chronic renal disease (5/30, 16,7%). Twenty (66,7%) patients presented overweight. Five patients (16,7%) had a Charlson comorbidity [1] score ≥3. Twenty-seven (90%) patients were virologically suppressed.CD4 count was >500 cell/mm 3 in 23/30 (76,6%) patients. An antiviral treatment for SARS-COV2 was administered, in addition to HIV treatment, in 5/30 patients (16,3%). Twenty-four patients (80%) recovered from covid-19, 3/30 (10%) required invasive mechanical ventilation, 2/30 (6,7%) patients died and 4/30 (13,3%) patients were still hospitalized. CONCLUSIONS: Most of the patients were virologically suppressed with CD4 > 500 mm3. Risk factors were the same as those described in other SARS-COV2 series, suggesting that HIV infection is probably not an independent risk factor for covid-19. Introduction : An acute respiratory disease caused by a novel coronavirus (SARSCOV2) is spreading from China since January 2020. Surprisingly, few cases of Covid-19 have been reported in people living with HIV (PLWHIV). Methods : Here we present a series of 30 PLWHIV diagnosed for SARS-COV2 infection. The principal outcome was to describe clinical characteristics of this population. Results : Eighteen (60%) patients were men, 10/30 (33,3%) women and 2/30 (6,7%) transgender women. Median age was 53,7 years (range 30-80 years) and 23/30 patients (76,7%) were born in a foreign country (out of France). The most common comorbidities were cardiovascular disease (11/30, 36,7%), hypertension (11/30, 36,7%), diabetes (9/30,30%) obesity (7/30, 23%) and chronic renal disease ( All participants gave their written consent to have their medical chart recorded in the electronic medical record system Nadis®, from which we extracted anonymized data. Clinical characteristics and outcomes of the study population are reported in Table 1 Twenty-seven (90%) patients were virologically supressed, 2/30 patients (6,7%) had a low level plasma HIV-RNA viral load (>20 and <70 copies/ml) and only 1/30 patient had a viral load > 10000 copies/ml. CD4 count was >500 cell/mm 3 in 23/30 (76,6%) patients. Positive SARS-COV2 protein chain reaction (PCR) was confirmed in 24/30 (80%) patients, 2/30 (6,7%) patients had negative SARS-COV2 PCR and typical covid-19 chest CT findings, while diagnosis was based on typical clinical presentation ( anosmia and/or ageusia) in 3/30 (10%) patients (nasopharyngeal swab not done). Median delay between symptoms onset and diagnosis was 7 days (range 1-16 days). Antiretroviral treatment was modified during hospitalization in only one patient (switch from a TDF to a TAF-containg regimen in order to prevent renal failure in a critic patient). An antiviral treatment for SARS-COV2 was administered, in addition to HIV treatment, in Study population reflects the characteristics of the population routinely followed-up at our center, with a high percentage of migrant patients (65, 1% in PLWHIV routinely followed up, 76,7% in the study population). Main comorbidities were cardiovascular disease, hypertension, diabetes, obesity, and chronic renal disease, all being classical covid-19 risks factors described in others studies [2, 3, 4, 5, 6] J o u r n a l P r e -p r o o f In a recent publication of 57.000 patients hospitalized with SARS-COV2 infection in 12 hospitals in New York City area, the median score of the Charlson Comorbidity Index was 4. [2] In our population, only five patients (16,7%) had a Charlson comorbidity score ≥3, but we included also outpatients and the median age was lower (53 vs 68 years). In the same study, percentage of patients requiring mechanical ventilation was 12.2%, similar to that observed in our study (10%), but mortality was higher (21% vs 6,7%), in line with higher comorbidity score. In our series, poorest outcomes and death were observed in patients with a high comorbidity score. Most patients (90%) were virologically suppressed, with a CD4 >500 (76,6%), suggesting a role of already described risk factors, rather than immunosuppression, for SARS-COV2 infection. Compared to others series of PLWHIV SARS-COV2 infected patients [7] [8] , a lower percentage of patients had specific antiviral treatment for Covid-19 (16,3%). Based on local guidelines, antiviral treatment was indicated only in hospitalized patients with severe disease (oxygen requirement > 3lpm). Five patients in our study population were treated with an antiretroviral combination containing a non lopinavir/r protease inhibitor (darunavir). supporting the lack of efficacy of this treatment for SARS-COV2 infection. [9] In conclusion most of the patients in our study were virologically suppressed with CD4>500 mm 3 . Risk factors were the same as those described in other SARS-COV2 series, suggesting that HIV infection is probably not an independent risk factor for covid-19 infection. Mortality was 6,7%. Poorest outcomes and death were observed in patients with a high The authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter discussed in this manuscript. The author received no specific funding for this work. The participants enrolled in this study gave their written consent to have their medical chart recorded in the medical record system NAdis. The CNIL approved anomydized data extraction from electronic medical records (CNIL number 1171457, 24 May 2006). No further ethical approval is needed for French law on personal data protection. The authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter discussed in this manuscript. J o u r n a l P r e -p r o o f Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region « Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19 » Risk Factors of Critical & Mortal COVID-19 Cases: A Systematic Literature Review and Meta-Analysis » « COVID-19 in Patients with HIV: Clinical Case Series COVID-19 ID Team. «Description of COVID-19 in HIV-infected individuals: a singlecentre, prospective cohort» Lancet HIV Darunavir Does Not Prevent SARS-CoV-2 Infection in HIV Patients Analysis of an ordinal endpoint for use in evaluating treatments for severe influenza requiring hospitalization Hypertension, dyslipidemia, hypertensive cardiomyopathy, chronic renal failure (1)