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Minkove SJ, Geiger G, Llibre JM, Montgomery MW, West NE, Chida NM, Antar AAR, Dandachi D, Weld ED, Karmen-Tuohy S, Carlucci PM, Zacharioudakis IM, Rahimian J, Zervou FN, Rebick G, Stachel A, Tang S, Ding D, Jones JL, Farley JE, Dooley KE, Wilgus BE, Sanchez M, Chow J, Kitchell E, Koh S, Maxwell D, Lau A, Brooks S, Chu J, Estrada J, Lazarte SM, Arinze F, Francis A, Paranjape N, Sax PE, Wanjalla CN, Kheshti AN, Bailin S, Koethe J, Kelly SG, Raffanti SP, Patel SM, Xu TH, Goebel M, Santiago ADD, Ray M, Slim J, Kratz AMP, Koren DE, Hiryak K, Hill B, Dare RK, Bordelon S, Bailey B, Baddley JW, Matthew Shoemaker D, Rodriguez-Nava G, Shweta FNU, Chu C, Pearson C, Treakle A, Furin JJ, Bogorodskaya M, Desai S, Osterholzer D, Arquiette J, Ford ES, Ching PR, Sun L, Buggy BP, Tirmizi A, Argentine S, Desai B, Swartz TH, Latimer D, Camazine M. Clinical outcomes after IL-6 blockade in patients with COVID-19 and HIV: a case series. AIDS Res Ther 2022; 19:6. [PMID: 35148782 PMCID: PMC8832430 DOI: 10.1186/s12981-022-00430-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/22/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In hospitalized people with HIV (PWH) there is an increased risk of mortality from COVID-19 among hospitalized PWH as compared to HIV-negative individuals. Evidence suggests that tocilizumab-a humanized monoclonal interleukin (IL)-6 receptor inhibitor (IL-6ri) antibody-has a modest mortality benefit when combined with corticosteroids in select hospitalized COVID-19 patients who are severely ill. Data on clinical outcomes after tocilizumab use in PWH with severe COVID-19 are lacking. CASE PRESENTATION We present a multinational case series of 18 PWH with COVID-19 who were treated with IL-6ri's during the period from April to June 2020. Four patients received tocilizumab, six sarilumab, and eight received an undocumented IL-6ri. Of the 18 patients in the series, 4 (22%) had CD4 counts < 200 cells/mm3; 14 (82%) had a suppressed HIV viral load. Eight patients (44%), all admitted to ICU, were treated for secondary infection; 5 had a confirmed organism. Of the four patients with CD4 counts < 200 cells/mm3, three were treated for secondary infection, with 2 confirmed organisms. Overall outcomes were poor-12 patients (67%) were admitted to the ICU, 11 (61%) required mechanical ventilation, and 7 (39%) died. CONCLUSIONS In this case series of hospitalized PWH with COVID-19 and given IL-6ri prior to the common use of corticosteroids, there are reports of secondary or co-infection in severely ill patients. Comprehensive studies in PWH, particularly with CD4 counts < 200 cells, are warranted to assess infectious and other outcomes after IL-6ri use, particularly in the context of co-administered corticosteroids.
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Dandachi D, Geiger G, Montgomery MW, Karmen-Tuohy S, Golzy M, Antar AAR, Llibre JM, Camazine M, Díaz-De Santiago A, Carlucci PM, Zacharioudakis IM, Rahimian J, Wanjalla CN, Slim J, Arinze F, Kratz AMP, Jones JL, Patel SM, Kitchell E, Francis A, Ray M, Koren DE, Baddley JW, Hill B, Sax PE, Chow J. Characteristics, Comorbidities, and Outcomes in a Multicenter Registry of Patients with HIV and Coronavirus Disease-19. Clin Infect Dis 2020; 73:e1964-e1972. [PMID: 32905581 PMCID: PMC7499544 DOI: 10.1093/cid/ciaa1339] [Citation(s) in RCA: 134] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Indexed: 12/24/2022] Open
Abstract
Background People with HIV (PWH) may have numerous risk factors for acquiring Coronavirus disease-19 (COVID-19) and developing severe outcomes, but current data are conflicting. Methods Healthcare providers enrolled consecutively by non-random sampling PWH with lab-confirmed COVID-19, diagnosed at their facilities between April 1st and July 1st, 2020. De-identified data were entered into an electronic Research Electronic Data Capture (REDCap). The primary endpoint was severe outcome, defined as a composite endpoint of intensive care unit (ICU) admission, mechanical ventilation, or death. The secondary outcome was the need for hospitalization. Results 286 patients were included; the mean age was 51.4 years (SD, 14.4), 25.9% were female, and 75.4% were African-American or Hispanic. Most patients (94.3%) were on antiretroviral therapy (ART), 88.7% had HIV virologic suppression, and 80.8% had comorbidities. Within 30 days of positive SARS-CoV-2 testing, 164 (57.3%) patients were hospitalized, and 47 (16.5%) required ICU admission. Mortality rates were 9.4% (27/286) overall, 16.5% (27/164) among those hospitalized, and 51.5% (24/47) among those admitted to an ICU. The primary composite endpoint occurred in 17.5% (50/286) of all patients and 30.5% (50/164) of hospitalized patients. Older age, chronic lung disease, and hypertension were associated with severe outcomes. A lower CD4 count (<200 cells/mm³) was associated with the primary and secondary endpoints. There was no association between the antiretroviral regimen or lack of viral suppression and predefined outcomes. Conclusion Severe clinical outcomes occurred commonly in PWH and COVID-19. The risk for poor outcomes was higher in those with comorbidities and lower CD4 cell counts, despite HIV viral suppression.
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Affiliation(s)
- Dima Dandachi
- Division of Infectious Diseases, University of Missouri-Columbia, MO
| | - Grant Geiger
- School of Medicine, University of Missouri-Columbia, MO
| | - Mary W Montgomery
- Department of Infectious Diseases, Brigham and Women's Hospital, Boston, MA
| | | | - Mojgan Golzy
- Department of Health Management and Informatics, University of Missouri-Columbia, MO
| | - Annukka A R Antar
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Josep M Llibre
- Infectious Diseases and Fight AIDS Foundation, University Hospital Germans Trias, Badalona, Spain
| | | | - Alberto Díaz-De Santiago
- Internal Medicine Department, HIV Infection Unit. Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
| | - Philip M Carlucci
- School of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Ioannis M Zacharioudakis
- Division of Infectious Diseases and Immunology, New York University Grossman School of Medicine, New York, NY
| | - Joseph Rahimian
- Division of Infectious Diseases and Immunology, New York University Grossman School of Medicine, New York, NY
| | - Celestine N Wanjalla
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN
| | - Jihad Slim
- Division of Infectious Diseases, Saint Michael's Medical Center, Newark, NJ
| | - Folasade Arinze
- Department of Internal Medicine, Wellstar Health System, Atlanta, GA
| | | | - Joyce L Jones
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shital M Patel
- Section of Infectious Diseases, Medicine, Baylor College of Medicine, TX
| | - Ellen Kitchell
- Division of Infectious Diseases, UT Southwestern Medical Center, TX
| | - Adero Francis
- Department of Internal Medicine, Wellstar Health System, Atlanta, GA
| | - Manoj Ray
- Division of Infectious Diseases, Santa Clara Valley Health & Hospital System, CA
| | - David E Koren
- Department of Pharmacy, Temple University Health System, PA
| | - John W Baddley
- Division of Infectious Disease, University of Maryland, Baltimore, MD
| | - Brannon Hill
- Department of Pharmacy, University of Arkansas for Medical Sciences, AR
| | - Paul E Sax
- Department of Infectious Diseases, Brigham and Women's Hospital, Boston, MA
| | - Jeremy Chow
- Division of Infectious Diseases, UT Southwestern Medical Center, TX
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