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Múñez-Rubio E, Calderón-Parra J, Gutiérrez-Villanueva A, Fernández-Cruz A, Ramos-Martínez A. Clinical experience in the treatment of COVID-19 with monoclonal antibodies in solid organ transplant recipients. Rev Esp Quimioter 2023; 36 Suppl 1:25-28. [PMID: 37997867 PMCID: PMC10793550 DOI: 10.37201/req/s01.07.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
Solid organ transplant (SOT) recipients are at high risk for complications from coronavirus disease 2019 (COVID-19). SOT recipients mount lower immunological responses to vaccines than general population and are at high risk for breakthrough COVID-19 infections. Passive immunotherapy in the form of anti-Spike monoclonal antibodies (MoAbs) may be an alternative for the prophylaxis and treatment of COVID-19 in these patients. SARS-CoV-2 has evolved by accumulating resistance mutations that have escaped the neutralizing action of most MoAbs. However, MoAbs directed at more conserved epitopes and that maintain effector functions could maintain efficacy in the treatment of these patients. According to published data, SOT recipients with low anti-spike antibody responses to vaccination could benefit from the use of MoAbs in pre-exposure prophylaxis, in the treatment of COVID-19 mild to moderate and severe COVID-19 with less than 15 days of symptom duration and low oxygen requirements. Combination therapy could be more effective than monotherapy for the treatment of mild-to-moderate SARS-CoV-2 infection.
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Affiliation(s)
- E Múñez-Rubio
- Elena Múñez-Rubio, Infectious Diseases Unit, Department of Internal Medicine, University Hospital Puerta de Hierro, Majadahonda, Spain.
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Moreno-Torres V, de Mendoza C, Martínez-Urbistondo M, Mills P, Treviño A, de la Fuente S, Díaz de Santiago A, Calderón-Parra J, Pintos-Pascual I, Corpas M, Soriano V. Predictors of in-hospital mortality in HIV-infected patients with COVID-19. QJM 2023; 116:57-62. [PMID: 36047831 DOI: 10.1093/qjmed/hcac215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Underlying immunodeficiency is associated with severe COVID-19, but the prognosis of persons with human immunodeficiency virus (HIV) (PWH) with COVID-19 is under debate. Aim: assessment of the mortality rate and major determinants of death in HIV-infected patients hospitalized with COVID-19 in Spain before vaccine availability. Design: Retrospective nationwide public database analysis. METHODS Nationwide, retrospective, observational analysis of all hospitalizations with COVID-19 during year 2020 in Spain. Stratification was made according to HIV status. The National Registry of Hospital Discharges was used with the ICD-10 coding list. RESULTS A total of 117 694 adults were hospitalized with COVID-19 during 2020. Only 234 (0.2%) were HIV-positives. More than 95% were on antiretroviral therapy. Compared to HIV-negatives, PWH were younger (mean age 53.2 vs. 66.5 years old; P<0.001) and more frequently male (74.8% vs. 56.6%; P<0.001). Most co-morbidities predisposing to severe COVID-19 (diabetes, hypertension, dementia and cardiovascular disease) were more frequent in HIV-negatives. In contrast, the rate of baseline liver disease was over 6-fold higher in PWH (27.4% vs. 4.4%; P<0.001). In-hospital mortality was lower in PWH (9.4% vs. 16%; P=0.004). In multivariate analysis, older age, dementia and especially advanced liver disease (relative risk (RR): 7.6) were the major determinants of death in PWH hospitalized with COVID-19. CONCLUSION HIV-infected patients hospitalized in Spain with COVID-19 during 2020 had better survival than HIV-negatives, most likely explained by younger age and lower rate of co-morbidities. However, advanced liver disease was a major predictor of death in PWH hospitalized with COVID-19.
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Affiliation(s)
- V Moreno-Torres
- Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Calle Joaquín Rodrigo 1, Majadahonda 28222, Madrid, Spain
| | - C de Mendoza
- Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Calle Joaquín Rodrigo 1, Majadahonda 28222, Madrid, Spain
- UNIR Health Sciences School and Medical Center, Calle García Martín 21, Pozuelo de Alarcón 28224, Madrid, Spain
| | - M Martínez-Urbistondo
- Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Calle Joaquín Rodrigo 1, Majadahonda 28222, Madrid, Spain
| | - P Mills
- Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Calle Joaquín Rodrigo 1, Majadahonda 28222, Madrid, Spain
| | - A Treviño
- UNIR Health Sciences School and Medical Center, Calle García Martín 21, Pozuelo de Alarcón 28224, Madrid, Spain
| | - S de la Fuente
- Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Calle Joaquín Rodrigo 1, Majadahonda 28222, Madrid, Spain
| | - A Díaz de Santiago
- Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Calle Joaquín Rodrigo 1, Majadahonda 28222, Madrid, Spain
| | - J Calderón-Parra
- Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Calle Joaquín Rodrigo 1, Majadahonda 28222, Madrid, Spain
| | - I Pintos-Pascual
- Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Calle Joaquín Rodrigo 1, Majadahonda 28222, Madrid, Spain
| | - M Corpas
- UNIR Health Sciences School and Medical Center, Calle García Martín 21, Pozuelo de Alarcón 28224, Madrid, Spain
- Genetics Unit, Cambridge Precision Medicine, Cambridge Biomedical Campus, Hills Road CB2 OAH, Cambridge, UK
| | - V Soriano
- UNIR Health Sciences School and Medical Center, Calle García Martín 21, Pozuelo de Alarcón 28224, Madrid, Spain
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