Clinical Features and Outcomes of Hospitalized Patients Co-Infected with COVID-19 and HIV: A Case Series

Abstract

INTRODUCTION Coronavirus-19 disease (COVID-19) caused by the novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) continues to be a major cause of mortality worldwide. Advanced age and a number of chronic diseases have been investigated as risk factors for poor outcomes in patients with COVID-19. Likewise, Human Immunodeficiency Virus (HIV) has been proposed as a potential risk factor for COVID-19, however, the possible relationship between HIV and COVID-19 has remained difficult to fully elucidate due to a paucity of data. We describe a case series of 11 patients co-infected with HIV and SARS-CoV-2. CASE PRESENTATION Between March 20, 2020 and May 5, 2020, 11 patients with HIV were admitted for COVID-19at an underserved community hospital in Brooklyn, NY. . Patients ranged from 39 to 78 years of age. Seven patients were men and four patients were women. Seven patients were African American and four patients were Hispanic. All 11 patients possessed HIV RNA viral loads less than 40 copies/ml. The mean CD4 count was 556 cells/ml (range 171-1123 cells/ml). Nine patients were on antiretroviral therapy (ART). Six patients required invasive mechanical ventilation;five of the six patients died. Two of these five patients were not on ART, prior to admission and two of them developed acute respiratory distress syndrome during their hospital course. The mean length of stay was 10.9 days (range 2-21 days). Three of the six survivors were readmitted within 30 days for CHF exacerbation, bacterial pneumonia and COPD exacerbation. All three patients recovered without complications. At six-month follow-up, no mortalities were reported among the six surviving patients. DISCUSSION This case series presents a unique sample of African American and Hispanic patients co-infected with HIV and SARS-CoV-2. This is the first case series to report long term outcomes among minority population. The high mortality rate in this case series (45%) is also notable in comparison to prior research. This elevated mortality rate may reflect an increased burden of comorbidities in HIV patients. Further research is required to reveal if ART therapy reduces risk of poor outcomes, and if so, which regimen may confer protection against COVID-19.