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Amegashie EA, Asamoah P, Ativi LEA, Adusei-Poku M, Bonney EY, Tagoe EA, Paintsil E, Torpey K, Quaye O. Clinical outcomes and immunological response to SARS-CoV-2 infection among people living with HIV. Exp Biol Med (Maywood) 2024; 249:10059. [PMID: 38628843 PMCID: PMC11020089 DOI: 10.3389/ebm.2024.10059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/22/2024] [Indexed: 04/19/2024] Open
Abstract
People living with HIV (PLWH) usually suffer from co-infections and co-morbidities including respiratory tract infections. SARS-CoV-2 has been reported to cause respiratory infections. There are uncertainties in the disease severity and immunological response among PLWH who are co-infected with COVID-19. This review outlines the current knowledge on the clinical outcomes and immunological response to SARS-CoV-2 among PLWH. Literature was searched in Google scholar, Scopus, PubMed, and Science Direct conforming with the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines from studies published from January 2020 to June 2023. A total of 81 studies from 25 countries were identified, and RT-PCR was used in confirming COVID-19 in 80 of the studies. Fifty-seven studies assessed risk factors and clinical outcomes in HIV patients co-infected with COVID-19. Thirty-nine of the studies indicated the following factors being associated with severe outcomes in HIV/SARS-CoV-2: older age, the male sex, African American race, smoking, obesity, cardiovascular diseases, low CD4+ count, high viral load, tuberculosis, high levels of inflammatory markers, chronic kidney disease, hypertension, diabetes, interruption, and delayed initiation of ART. The severe outcomes are patients' hospitalization, admission at intensive care unit, mechanical ventilation, and death. Twenty (20) studies, however, reported no difference in clinical presentation among co-infected compared to mono-infected individuals. Immune response to SARS-CoV-2 infection was investigated in 25 studies, with some of the studies reporting high levels of inflammatory markers, T cell exhaustion and lower positive conversion rate of IgG in PLWH. There is scanty information on the cytokines that predisposes to severity among HIV/SARS-CoV-2 co-infected individuals on combined ART. More research work should be carried out to validate co-infection-related cytokines and/or immune markers to SARS-CoV-2 among PLWH.
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Affiliation(s)
- Esimebia Adjovi Amegashie
- Department of Biochemistry, Cell and Molecular Biology, West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Accra, Ghana
| | - Prince Asamoah
- Department of Biochemistry, Cell and Molecular Biology, West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Accra, Ghana
| | - Lawrencia Emefa Ami Ativi
- Department of Medical Microbiology, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Mildred Adusei-Poku
- Department of Medical Microbiology, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Evelyn Yayra Bonney
- Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Emmanuel Ayitey Tagoe
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Elijah Paintsil
- Department of Paediatrics, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Kwasi Torpey
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Osbourne Quaye
- Department of Biochemistry, Cell and Molecular Biology, West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Accra, Ghana
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Leston M, Elson W, Ordóñez-Mena JM, Kar D, Whitaker H, Joy M, Roberts N, Hobbs FDR, de Lusignan S. Disparities in COVID-19 mortality amongst the immunosuppressed: A systematic review and meta-analysis for enhanced disease surveillance. J Infect 2024; 88:106110. [PMID: 38302061 PMCID: PMC10943183 DOI: 10.1016/j.jinf.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/18/2024] [Accepted: 01/20/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Effective disease surveillance, including that for COVID-19, is compromised without a standardised method for categorising the immunosuppressed as a clinical risk group. METHODS We conducted a systematic review and meta-analysis to evaluate whether excess COVID-associated mortality compared to the immunocompetent could meaningfully subdivide the immunosuppressed. Our study adhered to UK Immunisation against infectious disease (Green Book) criteria for defining and categorising immunosuppression. Using OVID (EMBASE, MEDLINE, Transplant Library, and Global Health), PubMed, and Google Scholar, we examined relevant literature between the entirety of 2020 and 2022. We selected for cohort studies that provided mortality data for immunosuppressed subgroups and immunocompetent comparators. Meta-analyses, grey literature and any original works that failed to provide comparator data or reported all-cause or paediatric outcomes were excluded. Odds Ratios (OR) and 95% confidence intervals (CI) of COVID-19 mortality were meta-analysed by immunosuppressed category and subcategory. Subgroup analyses differentiated estimates by effect measure, country income, study setting, level of adjustment, use of matching and publication year. Study screening, extraction and bias assessment were performed blinded and independently by two researchers; conflicts were resolved with the oversight of a third researcher. PROSPERO registration number is CRD42022360755. FINDINGS We identified 99 unique studies, incorporating data from 1,542,097 and 56,248,181 unique immunosuppressed and immunocompetent patients with COVID-19 infection, respectively. Compared to immunocompetent people (pooled OR, 95%CI), solid organ transplants (2.12, 1.50-2.99) and malignancy (2.02, 1.69-2.42) patients had a very high risk of COVID-19 mortality. Patients with rheumatological conditions (1.28, 1.13-1.45) and HIV (1.20, 1.05-1.36) had just slightly higher risks than the immunocompetent baseline. Case type, setting income and mortality data matching and adjustment were significant modifiers of excess immunosuppressed mortality for some immunosuppressed subgroups. INTERPRETATION Excess COVID-associated mortality among the immunosuppressed compared to the immunocompetent was seen to vary significantly across subgroups. This novel means of subdivision has prospective benefit for targeting patient triage, shielding and vaccination policies during periods of high disease transmission.
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Affiliation(s)
- Meredith Leston
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, United Kingdom.
| | - Willam Elson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, United Kingdom
| | - Jose M Ordóñez-Mena
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, United Kingdom
| | - Debasish Kar
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, United Kingdom
| | - Heather Whitaker
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Mark Joy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, United Kingdom
| | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Old Campus Road, Old Campus Research Building, Headington, Oxford OX3 7DQ, United Kingdom
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, United Kingdom
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, United Kingdom
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Giacomelli A, Gagliardini R, Tavelli A, De Benedittis S, Mazzotta V, Rizzardini G, Mondi A, Augello M, Antinori S, Vergori A, Gori A, Menozzi M, Taramasso L, Fusco FM, De Vito A, Mancarella G, Marchetti G, D'Arminio Monforte A, Antinori A, Cozzi-Lepri A. Risk of COVID-19 in-hospital mortality in people living with HIV compared to general population according to age and CD4 strata: data from the ICONA network. Int J Infect Dis 2023; 136:127-135. [PMID: 37741311 DOI: 10.1016/j.ijid.2023.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 09/25/2023] Open
Abstract
OBJECTIVES We aimed to study whether people living with HIV (PLWH) are at higher risk of in-hospital COVID-19 mortality compared to the general population (GenPop). METHODS This was a retrospective study in 19 Italian centers (February 2020 to November 2022) including hospitalized PLWH and GenPop with SARS-CoV-2 infection. The main outcome was in-hospital mortality. Competing risk analyses by Fine-Gray regression model were used to estimate the association between in-hospital mortality and HIV status/age. RESULTS A total of 7399 patients with COVID-19 were included, 239 (3.2%) PLWH, and 7160 (96.8%) GenPop. By day 40, in-hospital death occurred in 1283/7160 (17.9%) among GenPop and 34/239 (14.2%) among PLWH. After adjusting for potential confounders, compared to GenPop <65 years, a significantly higher risk of death was observed for GenPop ≥65 (adjusted subdistribution hazard ratio [aSHR] 1.79 [95% CI 1.39-2.31]), PLWH ≥65 (aSHR 2.16 [95% CI 1.15-4.04]), PLWH <65 with CD4 ≤200 (aSHR 9.69 [95% CI 5.50-17.07]) and PLWH <65 with CD4 201-350 (aSHR 4.37 [95% CI 1.79-10.63]), whereas no evidence for a difference for PLWH <65 with CD4 >350 (aSHR 1.11 [95% CI 0.41-2.99]). CONCLUSIONS In PLWH aged <65 years a CD4 ≤350 rather than HIV itself seems the driver for the observed higher risk of in-hospital mortality. We cannot however rule out that HIV infection per se is the risk factor in those aged ≥65 years.
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Affiliation(s)
- Andrea Giacomelli
- III Infectious Disease Unit, ASST Fatebenefratelli Sacco, Milan, Italy.
| | - Roberta Gagliardini
- Clinical Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy.
| | | | - Sara De Benedittis
- ASST Santi Paolo e Carlo, San Paolo Hospital, Unit of Infectious Diseases, Department of Health Sciences, University of Milan, Milan, Italy.
| | - Valentina Mazzotta
- Clinical Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy.
| | - Giuliano Rizzardini
- I Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy.
| | - Annalisa Mondi
- Clinical Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy.
| | - Matteo Augello
- ASST Santi Paolo e Carlo, San Paolo Hospital, Unit of Infectious Diseases, Department of Health Sciences, University of Milan, Milan, Italy.
| | - Spinello Antinori
- III Infectious Disease Unit, ASST Fatebenefratelli Sacco, Milan, Italy; Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi di Milano, Italy.
| | - Alessandra Vergori
- Clinical Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy.
| | - Andrea Gori
- II Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, University of Milan, Milan, Italy.
| | - Marianna Menozzi
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy.
| | - Lucia Taramasso
- Infectious Disease Clinic, IRCCS Policlinico San Martino Hospital, Genoa, Italy.
| | - Francesco Maria Fusco
- UOC Infezioni Sistemiche e dell'Immunodepresso, AORN Ospedali dei Colli, P.O. "D. Cotugno", Naples, Italy.
| | - Andrea De Vito
- Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy.
| | - Giulia Mancarella
- Infectious Diseases Unit, SM Goretti Hospital, Sapienza University of Rome, Latina, Italy.
| | - Giulia Marchetti
- ASST Santi Paolo e Carlo, San Paolo Hospital, Unit of Infectious Diseases, Department of Health Sciences, University of Milan, Milan, Italy.
| | | | - Andrea Antinori
- Clinical Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy.
| | - Alessandro Cozzi-Lepri
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK.
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Maro A, Rosenthal EM, Abdallah M, Tesoriero J, Dehovitz J. Are persons living with diagnosed HIV capable of mounting a strong inflammatory response to the new coronavirus? Int J STD AIDS 2023; 34:978-983. [PMID: 37498157 PMCID: PMC10375225 DOI: 10.1177/09564624231191814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/17/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND The impact of COVID-19 on persons living with diagnosed HIV (PLWDH) remains incompletely understood. It's unclear whether an impaired immune system offers protection against mounting cytokine storm. METHODS Retrospective matched cohort study of COVID-19 hospitalized individuals in New York State (NYS). Medical records were abstracted and analyzed for 853 PLWDH hospitalized with COVID-19 in NYS and 1621 HIV-negative controls. Preexisting comorbidities and inflammatory markers measured within 24 h of hospital admission were abstracted. RESULTS PLWDH were significantly less likely to have elevated inflammatory markers compared to matched controls. Elevated WBC occurred in 23.3% of PLWDH vs 30.1% of controls (p = .0002), elevated CRP in 37.4% of PLWDH vs 43.2% of controls (p = .03), elevated ferritin in 73.4% of PLWDH vs 78.9% of controls (p = .004). There was an inverse but not statistically significant relationship between the frequency of elevated inflammatory markers and HIV disease stage, with greatest percent of PLWDH with elevated WBC, LDH, CRP, and ferritin among PLWDH with HIV disease stage 1. CONCLUSION PLWDH had lower inflammatory marker elevation during COVID-19 infection compared to matched controls. PLWDH with low CD4 were less likely to mount a cytokine storm in the setting of impaired immune function.
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Affiliation(s)
- Anna Maro
- Division of Infectious Diseases, NYC Health and Hospitals Kings County, Brooklyn, NY, USA
| | - Elizabeth M. Rosenthal
- Center for Program Development, Implementation, Research and Evaluation, AIDS Institute, New York State Department of Health, Albany, NY, USA
| | - Marie Abdallah
- Division of Infectious Diseases, NYC Health and Hospitals Kings County, Brooklyn, NY, USA
| | - James Tesoriero
- Center for Program Development, Implementation, Research and Evaluation, AIDS Institute, New York State Department of Health, Albany, NY, USA
- Center for Collaborative HIV Research in Practice and Policy, University at Albany School of Public Health, State University of New York, Rensselaer, NY, USA
| | - Jack Dehovitz
- Center for Collaborative HIV Research in Practice and Policy, University at Albany School of Public Health, State University of New York, Rensselaer, NY, USA
- Downstate Health Sciences University, State University of New York, Brooklyn, NY, USA
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5
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San Martín-López JV, Mesa N, Bernal-Bello D, Morales-Ortega A, Rivilla M, Guerrero M, Calderón R, Farfán AI, Rivas L, Soria G, Izquierdo A, Madroñal E, Duarte M, Piedrabuena S, Toledano-Macías M, Marrero J, de Ancos C, Frutos B, Cristóbal R, Velázquez L, Mora B, Cuenca P, Satué JÁ, Ayala-Larrañaga I, Carpintero L, Lara C, Llerena ÁR, García V, García de Viedma V, Prieto S, González-Pereira N, Bravo C, Mariño C, Lechuga LA, Tarancón J, Gonzalo S, Moreno S, Ruiz-Giardin JM. Seven Epidemic Waves of COVID-19 in a Hospital in Madrid: Analysis of Severity and Associated Factors. Viruses 2023; 15:1839. [PMID: 37766248 PMCID: PMC10538062 DOI: 10.3390/v15091839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/21/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: COVID-19 has evolved during seven epidemic waves in Spain. Our objective was to describe changes in mortality and severity in our hospitalized patients. (2) Method: This study employed a descriptive, retrospective approach for COVID-19 patients admitted to the Hospital de Fuenlabrada (Madrid, Spain) until 31 December 2022. (3) Results: A total of 5510 admissions for COVID-19 were recorded. The first wave accounted for 1823 (33%) admissions and exhibited the highest proportion of severe patients: 65% with bilateral pneumonia and 83% with oxygen saturation under 94% during admission and elevated levels of CRP, IL-6, and D-dimer. In contrast, the seventh wave had the highest median age (79 years) and comorbidity (Charlson: 2.7), while only 3% of patients had bilateral pneumonia and 3% required intubation. The overall mortality rate was 10.3%. The first wave represented 39% of the total. The variables related to mortality were age (OR: 1.08, 1.07-1.09), cancer (OR: 1.99, 1.53-2.60), dementia (OR: 1.82, 1.20-2.75), the Charlson index (1.38, 1.31-1.47), the need for high-flow oxygen (OR: 6.10, 4.94-7.52), mechanical ventilation (OR: 11.554, 6.996-19.080), and CRP (OR: 1.04, 1.03-1.06). (4) Conclusions: The variables associated with mortality included age, comorbidity, respiratory failure, and inflammation. Differences in the baseline characteristics of admitted patients explained the differences in mortality in each wave. Differences observed between patients admitted in the latest wave and the earlier ones suggest that COVID-19 has evolved into a distinct disease, requiring a distinct approach.
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Affiliation(s)
- Juan Víctor San Martín-López
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, 28029 Madrid, Spain;
| | - Nieves Mesa
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - David Bernal-Bello
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Alejandro Morales-Ortega
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
- Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, 28871 Madrid, Spain
| | - Marta Rivilla
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Marta Guerrero
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Ruth Calderón
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Ana I. Farfán
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Luis Rivas
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Guillermo Soria
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Aída Izquierdo
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Elena Madroñal
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Miguel Duarte
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Sara Piedrabuena
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - María Toledano-Macías
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Jorge Marrero
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Cristina de Ancos
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Begoña Frutos
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Rafael Cristóbal
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Laura Velázquez
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Belén Mora
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Paula Cuenca
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - José Á. Satué
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Ibone Ayala-Larrañaga
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Lorena Carpintero
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Celia Lara
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Álvaro R. Llerena
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Virginia García
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Vanessa García de Viedma
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Santiago Prieto
- Servicio de Laboratorio Clínico, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (S.P.); (N.G.-P.)
| | - Natalia González-Pereira
- Servicio de Laboratorio Clínico, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (S.P.); (N.G.-P.)
| | - Cristina Bravo
- Servicio de Farmacia, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (C.B.); (C.M.)
| | - Carolina Mariño
- Servicio de Farmacia, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (C.B.); (C.M.)
| | - Luis Antonio Lechuga
- Sistemas, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (L.A.L.); (J.T.)
| | - Jorge Tarancón
- Sistemas, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (L.A.L.); (J.T.)
| | - Sonia Gonzalo
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Santiago Moreno
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, 28029 Madrid, Spain;
- Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, 28871 Madrid, Spain
- Servicio de Enfermedades Infecciosas, Hospital U. Ramón y Cajal, IRYCIS, 28034 Madrid, Spain
| | - José M. Ruiz-Giardin
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, 28029 Madrid, Spain;
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Rosenthal EM, Patterson W, Chicoine J, Dorabawila V, Adamashvili N, Rajulu DT, Rosenberg ES, Tesoriero JM. COVID-19 Vaccination and Hospitalization Among Persons Living With Diagnosed HIV in New York State. J Acquir Immune Defic Syndr 2023; 93:92-100. [PMID: 36853763 PMCID: PMC10179975 DOI: 10.1097/qai.0000000000003177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/26/2023] [Accepted: 02/09/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Persons living with diagnosed HIV (PLWDH) have higher COVID-19 diagnoses rates and poorer COVID-19-related outcomes than persons living without diagnosed HIV. The intersection of COVID-19 vaccination status and likelihood of severe COVID-19 outcomes has not been fully investigated for PLWDH. SETTING New York State (NYS). METHODS We matched HIV surveillance, immunization, and hospitalization databases to compare COVID-19 vaccination and COVID-19-related hospitalizations among PLWDH during B.1.617.2 (Delta) and B.1.1.529 (Omicron) predominance. RESULTS Through March 4, 2022, 69,137 of the 101,205 (68%) PLWDH were fully vaccinated or boosted for COVID-19. PLWDH who were virally suppressed or in care were more often to be fully vaccinated or boosted compared with PLWDH who were not virally suppressed (77% vs. 44%) or without evidence of care (74% vs. 33%). Overall hospitalization rates were lower among virally suppressed PLWDH. During Delta predominance, PLWDH with any vaccination history who were in care had lower hospitalization rates compared with those not in care; during Omicron predominance, this was the case only for boosted PLWDH. CONCLUSIONS Approximately 28% (28,255) of PLWDH in NYS remained unvaccinated for COVID-19, a rate roughly double of that observed in the overall adult NYS population. PLWDH of color were more often than non-Hispanic White persons to be unvaccinated, as were the virally unsuppressed and those without evidence of HIV-related care, threatening to expand existing disparities in COVID-19-related outcomes. Vaccination was protective against COVID-19-related hospitalizations for PLWDH; however, differences in hospitalization rates between fully vaccinated and unvaccinated PLWDH were smaller than those among all New Yorkers.
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Affiliation(s)
- Elizabeth M. Rosenthal
- Center for Program Development, Implementation, Research and Evaluation, AIDS Institute, New York State Department of Health, Albany, NY
- University at Albany School of Public Health, State University at New York, Rensselaer, NY
- Center for Collaborative HIV Research in Practice and Policy, University at Albany School of Public Health, State University of New York, Rensselaer, NY
| | - Wendy Patterson
- Division of Epidemiology, Evaluation and Partner Services, AIDS Institute, New York State Department of Health, Albany, NY
| | - Joyce Chicoine
- Division of Epidemiology, Evaluation and Partner Services, AIDS Institute, New York State Department of Health, Albany, NY
| | - Vajeera Dorabawila
- Division of Epidemiology, Center for Community Health, New York State Department of Health, Albany, NY
| | - Natalia Adamashvili
- Center for Program Development, Implementation, Research and Evaluation, AIDS Institute, New York State Department of Health, Albany, NY
- Department of Public Health, Faculty of Medicine, Tbilisi State University; and
| | - Deepa T. Rajulu
- Division of Epidemiology, Evaluation and Partner Services, AIDS Institute, New York State Department of Health, Albany, NY
| | - Eli S. Rosenberg
- University at Albany School of Public Health, State University at New York, Rensselaer, NY
- Center for Collaborative HIV Research in Practice and Policy, University at Albany School of Public Health, State University of New York, Rensselaer, NY
- Office of Public Health, New York State Department of Health, Albany, NY
| | - James M. Tesoriero
- Center for Program Development, Implementation, Research and Evaluation, AIDS Institute, New York State Department of Health, Albany, NY
- University at Albany School of Public Health, State University at New York, Rensselaer, NY
- Center for Collaborative HIV Research in Practice and Policy, University at Albany School of Public Health, State University of New York, Rensselaer, NY
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Zsichla L, Müller V. Risk Factors of Severe COVID-19: A Review of Host, Viral and Environmental Factors. Viruses 2023; 15:175. [PMID: 36680215 PMCID: PMC9863423 DOI: 10.3390/v15010175] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
The clinical course and outcome of COVID-19 are highly variable, ranging from asymptomatic infections to severe disease and death. Understanding the risk factors of severe COVID-19 is relevant both in the clinical setting and at the epidemiological level. Here, we provide an overview of host, viral and environmental factors that have been shown or (in some cases) hypothesized to be associated with severe clinical outcomes. The factors considered in detail include the age and frailty, genetic polymorphisms, biological sex (and pregnancy), co- and superinfections, non-communicable comorbidities, immunological history, microbiota, and lifestyle of the patient; viral genetic variation and infecting dose; socioeconomic factors; and air pollution. For each category, we compile (sometimes conflicting) evidence for the association of the factor with COVID-19 outcomes (including the strength of the effect) and outline possible action mechanisms. We also discuss the complex interactions between the various risk factors.
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Affiliation(s)
- Levente Zsichla
- Institute of Biology, Eötvös Loránd University, 1117 Budapest, Hungary
- National Laboratory for Health Security, Eötvös Loránd University, 1117 Budapest, Hungary
| | - Viktor Müller
- Institute of Biology, Eötvös Loránd University, 1117 Budapest, Hungary
- National Laboratory for Health Security, Eötvös Loránd University, 1117 Budapest, Hungary
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Moran CA, Oliver NT, Szabo B, Collins LF, Nguyen MLT, Shah NS, Moanna A, Colasanti JA, Cantos VD, Armstrong WS, Sheth AN, Ofotokun I, Kelley CF, Marconi VC, Lahiri CD. The association between comorbidities and coronavirus disease 2019 hospitalization among people with HIV differs by age. AIDS 2023; 37:71-81. [PMID: 36111530 PMCID: PMC9742289 DOI: 10.1097/qad.0000000000003386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To determine whether factors associated with coronavirus disease 2019 (COVID-19) hospitalization among people with HIV (PWH) differ by age stratum. DESIGN Retrospective cohort study. METHODS All adult PWH with a positive SARS-CoV-2 PCR in a public safety-net health system between 1 March 2020 and 28 February 2021 and a Veterans Affairs Medical Center between 1 1 March 2020 and 15 November 2020 in Atlanta, Georgia were included. We performed multivariable logistic regression to determine demographic and clinical factors associated with COVID-19 hospitalization overall and stratified by age less than 50 and at least 50 years. RESULTS Three hundred and sixty-five PWH (mean age 49 years, 74% cisgender male, 82% black) were included. Ninety-six percent were on antiretroviral therapy (ART), 87% had CD4 + T-cell count at least 200 cells/μl, and 89% had HIV-1 RNA less than 200 copies/ml. Overall, age [adjusted odds ratio (aOR) 95% confidence interval (CI) 1.07 (1.04-1.10)], later date of SARS-CoV-2 infection [aOR 0.997 (0.995-1.00)], heart disease [aOR 2.27 (1.06-4.85)], and history of hepatitis C virus (HCV) [aOR 2.59 (1.13-5.89)] were associated with COVID-19 hospitalization. Age-adjusted comorbidity burden was associated with 30% increased risk of hospitalization [aOR 1.30 (1.11-1.54)]. Among 168 PWH less than 50 years old, older age [aOR 1.09 (1.01-1.18)] and no ART use [aOR 40.26 (4.12-393.62)] were associated with hospitalization; age-adjusted comorbidity burden was not ( P = 0.25). Among 197 PWH at least 50, older age [aOR 1.10 (1.04-1.16)], heart disease [aOR 2.45 (1.04-5.77)], history of HCV [aOR 3.52 (1.29-9.60)], and age-adjusted comorbidity burden [aOR 1.36 (1.12-1.66)] were associated with hospitalization. CONCLUSION Comorbidity burden is more strongly associated with COVID-19 hospitalization among older, rather than younger, PWH. These findings may have important implications for risk-stratifying COVID-19 therapies and booster recommendations in PWH.
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Affiliation(s)
- Caitlin A Moran
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Grady Health System, Atlanta
| | - Nora T Oliver
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Atlanta Veterans Affairs Medical Center, Decatur
| | | | - Lauren F Collins
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Grady Health System, Atlanta
| | - Minh Ly T Nguyen
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Grady Health System, Atlanta
| | - N Sarita Shah
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Atlanta Veterans Affairs Medical Center, Decatur
- Department of Epidemiology
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Abeer Moanna
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Atlanta Veterans Affairs Medical Center, Decatur
| | - Jonathan A Colasanti
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Grady Health System, Atlanta
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Valeria D Cantos
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Grady Health System, Atlanta
| | - Wendy S Armstrong
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Grady Health System, Atlanta
| | - Anandi N Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Grady Health System, Atlanta
| | - Ighovwerha Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Grady Health System, Atlanta
| | - Colleen F Kelley
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Grady Health System, Atlanta
| | - Vincent C Marconi
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Grady Health System, Atlanta
- Atlanta Veterans Affairs Medical Center, Decatur
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Cecile D Lahiri
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Grady Health System, Atlanta
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Lamacchia G, Salvati L, Kiros ST, Mazzoni A, Vanni A, Capone M, Carnasciali A, Farahvachi P, Lagi F, Di Lauria N, Rocca A, Colao MG, Liotta F, Cosmi L, Rossolini GM, Bartoloni A, Maggi L, Annunziato F. Fourth Dose of mRNA COVID-19 Vaccine Transiently Reactivates Spike-Specific Immunological Memory in People Living with HIV (PLWH). Biomedicines 2022; 10:3261. [PMID: 36552017 PMCID: PMC9775459 DOI: 10.3390/biomedicines10123261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/06/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Background: People Living With HIV (PLWH), with advanced disease, lower CD4+ T cell counts or an unsuppressed HIV viral load can have a suboptimal vaccine response. For this reason, in the current COVID-19 pandemic, they represent a prioritized population for the SARS-CoV-2 fourth (or second booster) vaccine dose. This work aims to investigate the effects of a second booster on the reactivation of the spike-specific humoral and cell-mediated immune responses in PLWH. Methods: A total of eight PLWH, who received a fourth dose of the original mRNA vaccines were enrolled. They were evaluated before and then 7 days, 1 month and 2 months after the injection. The humoral response was assessed via a chemiluminescent immunoassay. Immunophenotyping and the functional evaluation of the SARS-CoV-2-specific cellular immune responses were performed via flow cytometry. Results: Anti-spike IgG levels were above the cut-off value for all subjects at all timepoints. The spike-specific CD4+ T cell response was reactivated one week after the fourth vaccine dose, and on average declined at two months post-vaccination. A similar trend was observed for the spike-specific B cells. A low percentage of spike-specific CD4+ T cells was activated by the B.1.1.529 BA.1 Omicron-spike mutated peptides, and the majority of these cells were reactive to the conserved portions of the spike protein. Similarly, the majority of the spike-specific memory B cells were able to bind both Wuhan and Omicron-spike entire protein. Conclusions: Spike-specific adaptive immune responses are transiently reactivated in PLWH following the fourth mRNA vaccine dose. The breadth of the immune responses to the mutated spike protein provides insight on the possible cross-reactivity for the SARS-CoV-2 variants of concern (VOCs).
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Affiliation(s)
- Giulia Lamacchia
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
| | - Lorenzo Salvati
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
| | - Seble Tekle Kiros
- Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Alessio Mazzoni
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
- Flow Cytometry Diagnostic Center and Immunotherapy, Careggi University Hospital, 50134 Florence, Italy
| | - Anna Vanni
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
| | - Manuela Capone
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
- Flow Cytometry Diagnostic Center and Immunotherapy, Careggi University Hospital, 50134 Florence, Italy
| | - Alberto Carnasciali
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
| | - Parham Farahvachi
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
| | - Filippo Lagi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Nicoletta Di Lauria
- Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Arianna Rocca
- Microbiology and Virology Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Maria Grazia Colao
- Microbiology and Virology Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Francesco Liotta
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
- Flow Cytometry Diagnostic Center and Immunotherapy, Careggi University Hospital, 50134 Florence, Italy
- Immunology and Cell Therapy Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Lorenzo Cosmi
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
- Immunoallergology Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
- Microbiology and Virology Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Laura Maggi
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
| | - Francesco Annunziato
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
- Flow Cytometry Diagnostic Center and Immunotherapy, Careggi University Hospital, 50134 Florence, Italy
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Spence AB, Desale S, Lee J, Kumar P, Huang X, Cooper SE, Fernandez S, Kassaye SG. COVID-19 Outcomes in a US Cohort of Persons Living with HIV (PLWH). REPORTS 2022; 5:41. [PMID: 37063094 PMCID: PMC10104440 DOI: 10.3390/reports5040041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023] Open
Abstract
Reported coronavirus disease 2019 (COVID-19) outcomes in persons living with HIV (PLWH) vary across cohorts. We examined clinical characteristics and outcomes of PLWH with COVID-19 compared with a matched HIV-seronegative cohort in a mid-Atlantic US healthcare system. Multivariate logistic regression was used to explore factors associated with hospitalization and death/mechanical ventilation among PLWH. Among 281 PLWH with COVID-19, the mean age was 51.5 (SD 12.74) years, 63% were male, 86% were Black, and 87% had a HIV viral load <200 copies/mL. Overall, 47% of PLWH versus 24% (p < 0.001) of matched HIV-seronegative individuals were hospitalized. Rates of COVID-19 associated cardiovascular and thrombotic events, AKI, and infections were similar between PLWH and HIV-seronegative individuals. Overall mortality was 6% (n = 18/281) in PLWH versus 3% (n = 33/1124) HIV-seronegative, p < 0.0001. Among admitted patients, mortality was 14% (n = 18/132) for PLWH and 13% (n = 33/269) for HIV-seronegative, p = 0.75. Among PLWH, hospitalization associated with older age aOR 1.04 (95% CI 1.01, 1.06), Medicaid insurance aOR 2.61 (95% CI 1.39, 4.97) and multimorbidity aOR 2.98 (95% CI 1.72, 5.23). Death/mechanical ventilation associated with older age aOR 1.06 (95% CI 1.01, 1.11), Medicaid insurance aOR 3.6 (95% CI 1.36, 9.74), and multimorbidity aOR 4.4 (95% CI 1.55, 15.9) in adjusted analyses. PLWH were hospitalized more frequently than the HIV-seronegative group and had a higher overall mortality rate, but once hospitalized had similar mortality rates. Older age, multimorbidity and insurance status associated with more severe outcomes among PLWH suggesting the importance of targeted interventions to mitigate the effects of modifiable inequities.
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Affiliation(s)
- Amanda Blair Spence
- Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC 20007, USA
- Correspondence:
| | - Sameer Desale
- MedStar Health Research Institute, Hyattsville, MD 20782, USA
| | - Jennifer Lee
- Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC 20007, USA
| | - Princy Kumar
- Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC 20007, USA
| | - Xu Huang
- MedStar Health Research Institute, Hyattsville, MD 20782, USA
| | - Stanley Evan Cooper
- Department of Medicine, Georgetown University Medical Center, Washington, DC 20007, USA
| | | | - Seble G. Kassaye
- Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC 20007, USA
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11
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SARS-CoV-2 and HIV: Impact on Pulmonary Epithelial Cells. Life (Basel) 2022; 12:life12091317. [PMID: 36143354 PMCID: PMC9500782 DOI: 10.3390/life12091317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/19/2022] [Accepted: 08/22/2022] [Indexed: 11/25/2022] Open
Abstract
The SARS-CoV-2 pandemic provides a natural opportunity for the collision of coronavirus disease-2019 (COVID-19) with chronic infections, which place numerous individuals at high risk of severe COVID-19. Infection with Human Immunodeficiency Virus (HIV), a global epidemic, remains a major public health concern. Whether prior HIV+ status exacerbates COVID-19 warrants investigation. Herein, we characterized the impact of SARS-CoV-2 in human bronchial epithelial cells (HBECs) previously exposed to HIV. We optimized the air-liquid interface (ALI) cell culture technique to allow for challenges with HIV at the basolateral cell surface and SARS-CoV-2 spike protein on the apical surface, followed by genetic analyses for cellular stress/toxicity and innate/adaptive immune responses. Our results suggest that the IL-10 pathway was consistently activated in HBECs treated with spike, HIV, or a combination. Recombinant spike protein elicited COVID-19 cytokine storms while HIV activated different signaling pathways. HIV-treated HBECs could no longer activate NF-kB, pro-inflammatory TRAF-6 ubiquitination nor RIP1 signaling. Combinations of HIV and SARS-CoV-2 spike increased gene expression for activation of endoplasmic reticulum-phagosome pathway and downregulated non-canonical NF-kB pathways that are key in functional regulatory T cells and RNA Polymerase II transcription. Our in vitro studies suggest that prior HIV infection may not exacerbate COVID-19. Further in vivo studies are warranted to advance this field.
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