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1: HIV and risk of COVID-19 death: a population cohort study from the Western Cape Province, South Africa.
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Posted 03 Jul 2020

HIV and risk of COVID-19 death: a population cohort study from the Western Cape Province, South Africa.
4,978 downloads medRxiv hiv aids

Western Cape Department of Health with National Institute for Communicable Diseases, South Africa, Mary-Ann Davies

Background: The effect of HIV co-infection on COVID-19 outcomes in sub-Saharan Africa is unknown. Methods: We conducted a population cohort study using linked data from adults attending public sector health facilities in the Western Cape, South Africa. We used Cox-proportional hazards models adjusted for age, sex, location and comorbidities to examine the association between HIV and COVID-19 death among (i) public sector 'active patients' (at least 1 health visit in the 3 years before March 2020), (ii) laboratory-diagnosed COVID-19 cases and (iii) hospitalized COVID-19 cases. COVID-19 was diagnosed with SARS-CoV-2 PCR tests. We calculated the standardized mortality ratio (SMR) for COVID-19 comparing HIV positive vs. negative adults using modelled population estimates. Results: Among 3,460,932 public sector patients (16% HIV positive), 22,308 were diagnosed with COVID-19, of whom 625 died. In adjusted analysis, HIV increased risk of COVID-19 mortality (adjusted hazard ratio [aHR]:2.14; 95% confidence interval [CI]:1.70; 2.70), with similar risks across strata of viral load and immunosuppression. increased HIV-associated risk of COVID-19 death remained when restricting to COVID-19 cases (aHR:1.70; 95%CI:132; 2.18) or hospitalized cases (aHR:1.45; 95%CI:1.14; 1.84). Current and previous tuberculosis also increased COVID-19 mortality risk (aHR [95%CI]:2.70 [1.81; 4.04] and 1.51 [1.18; 1.93] respectively). The SMR for COVID-19 death associated with HIV was 2.39 (95% CI:1.96; 2.86); population attributable fraction 8.5% (95%CI:6.1; 11.1). Conclusion: HIV was associated with a doubling of COVID-19 mortality risk. While our findings may over-estimate the HIV-associated risk COVID-19 death due to residual confounding, people with HIV should be considered a high-risk group for COVID-19 management.

2: Estimation of the Potential Impact of COVID-19 Responses on the HIV Epidemic: Analysis using the Goals Model
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Posted 08 May 2020

Estimation of the Potential Impact of COVID-19 Responses on the HIV Epidemic: Analysis using the Goals Model
3,065 downloads medRxiv hiv aids

John Stover, Newton Chagoma, Issac Taramusi, Yu Teng, Robert Glaubius, Severin Guy Mahiane

We applied a simulation model of HIV to analyze the effects of 3 and 6-month disruptions in health services as a result of COVID-19. We found that disruptions to primary prevention programs (male circumcision, behavior change programs, condom distribution) would have small but transitory effects on new infections that might be more than offset by reductions in commercial and multi-partner sex due to lock downs. However, if COVID-19 leads to disruptions in ART services the impacts on mortality could be severe, doubling or tripling the estimated number of HIV deaths in 2020.

3: Projected HIV and Bacterial STI Incidence Following COVID-Related Sexual Distancing and Clinical Service Interruption
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Posted 30 Sep 2020

Projected HIV and Bacterial STI Incidence Following COVID-Related Sexual Distancing and Clinical Service Interruption
2,724 downloads medRxiv hiv aids

Samuel M Jenness, Adrien Le Guillou, Christina Chandra, Laura M Mann, Travis Sanchez, Daniel Westreich, Julia L Marcus

BackgroundThe global COVID-19 pandemic has the potential to indirectly impact the transmission dynamics and prevention of HIV and other sexually transmitted infections (STI). Studies have already documented reductions in sexual activity ("sexual distancing") and interruptions in HIV/STI services, but it is unknown what combined impact these two forces will have on HIV/STI epidemic trajectories. MethodsWe adapted a network-based model of co-circulating HIV, gonorrhea, and chlamydia for a population of approximately 103,000 men who have sex with men (MSM) in the Atlanta area. Model scenarios varied the timing, overlap, and relative extent of COVID-related sexual distancing in casual and one-time partnership networks and service interruption within four service categories (HIV screening, HIV PrEP, HIV ART, and STI treatment). ResultsA 50% relative decrease in sexual partnerships and interruption of all clinical services, both lasting 18 months, would generally offset each other for HIV (total 5-year population impact for Atlanta MSM: -227 cases), but have net protective effect for STIs (-23,800 cases). Greater relative reductions and longer durations of service interruption would increase HIV and STI incidence, while greater relative reductions and longer durations of sexual distancing would decrease incidence of both. If distancing lasted only 3 months but service interruption lasted 18 months, the total 5-year population impact would be an additional 890 HIV cases and 57,500 STI cases. ConclusionsThe counterbalancing impact of sexual distancing and clinical service interruption depends on the infection and the extent and durability of these COVID-related changes. If sexual behavior rebounds while service interruption persists, we project an excess of hundreds of HIV cases and thousands of STI cases just among Atlanta MSM over the next 5 years. Immediate action to limit the impact of service interruptions is needed to address the indirect effects of the global COVID pandemic on the HIV/STI epidemic.

4: HIV status alters disease severity and immune cell responses in beta variant SARS-CoV-2 infection wave
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Posted 24 Nov 2020

HIV status alters disease severity and immune cell responses in beta variant SARS-CoV-2 infection wave
1,953 downloads medRxiv hiv aids

Farina Karim, Inbal Gazy, Sandile Cele, Yenzekile Zungu, Robert Krause, Mallory Bernstein, Yashica Ganga, Hylton Rodel, Ntombifuthi Mthabela, Matilda Mazibuko, Khadija Khan, Daniel Muema, Dirhona Ramjit, Gila Lustig, Thumbi Ndung'u, Willem Hanekom, Bernadett I Gosnell, COMMIT-KZN Team, Emily Wong, Tulio de Oliveira, Mahomed-Yunus S Moosa, Alasdair Leslie, Henrik Kloverpris, Alex Sigal

There are conflicting reports on the effects of HIV on COVID-19. Here we analyzed disease severity and immune cell changes during and after SARS-CoV-2 infection in 236 participants from South Africa, of which 39% were people living with HIV (PLWH), during the first and second (beta dominated) infection waves. The second wave had more PLWH requiring supplemental oxygen relative to HIV negative participants. Higher disease severity was associated with low CD4 T cell counts and higher neutrophil to lymphocyte ratios (NLR). Yet, CD4 counts recovered and NLR stabilized after SARS-CoV-2 clearance in wave 2 infected PLWH, arguing for an interaction between SARS-CoV-2 and HIV infection leading to low CD4 and high NLR. The first infection wave, where severity in HIV negative and PLWH was similar, still showed some HIV modulation of SARS-CoV-2 immune responses. Therefore, HIV infection can synergize with the SARS-CoV-2 variant to change COVID-19 outcomes.

5: COVID-19 in people living with human immunodeficiency virus: A case series of 33 patients
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Posted 01 May 2020

COVID-19 in people living with human immunodeficiency virus: A case series of 33 patients
1,848 downloads medRxiv hiv aids

Georg Haerter, Christoph D. Spinner, Julia Roider, Markus Bickel, Ivanka Krznaric, Stephan Grunwald, Farhad Schabaz, Daniel Gillor, Nils Postel, Matthias C Mueller, Markus Mueller, Katja Roemer, Knud Schewe, Christian Hoffmann

Data on people living with human immunodeficiency virus (PLWH) in the current SARS-CoV-2 pandemic is still scarce. This case series of 33 PLWH patients with COVID-19 reveals symptoms and outcome in this special population. Three out of 32 patients with documented outcome died (9%). However, 91% of the patients recovered and 76% have been classified as mild cases, indicating that there is no excess morbidity and mortality among PLWH with symptomatic COVID-19. All patients were on antiretroviral treatment, of them 22 on tenofovir-containing regimen, and 4 on the protease inhibitor darunavir.

6: A high-resolution HLA reference panel capturing global population diversity enables multi-ethnic fine-mapping in HIV host response
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Posted 18 Jul 2020

A high-resolution HLA reference panel capturing global population diversity enables multi-ethnic fine-mapping in HIV host response
1,776 downloads medRxiv hiv aids

Yang Luo, Masahiro Kanai, Wanson Choi, Xinyi Li, Kenichi Yamamoto, Kotaro Ogawa, Maria Gutierrez-Arcelus, Peter K Gregersen, Philip E Stuart, James T Elder, Jacques Fellay, Mary Carrington, David W. Haas, Xiuqing Guo, Nicholette D Palmer, Yii-Der Ida Chen, Jerome I. Rotter, Kent Taylor, Steve Rich, Adolfo Correa, James G Wilson, Sekar Kathiresan, Michael Cho, Andres Metspalu, Tonu Esko, Yukinori Okada, Buhm Han, NHLBI Trans-Omics for Precision Medicine (TOPMed) Consortium, Paul J Mclaren, Soumya Raychaudhuri

Defining causal variation by fine-mapping can be more effective in multi-ethnic genetic studies, particularly in regions such as the MHC with highly population-specific structure. To enable such studies, we constructed a large (N=21,546) high resolution HLA reference panel spanning five global populations based on whole-genome sequencing data. Expectedly, we observed unique long-range HLA haplotypes within each population group. Despite this, we demonstrated consistently accurate imputation at G-group resolution (94.2%, 93.7%, 97.8% and 93.7% in Admixed African (AA), East Asian (EAS), European (EUR) and Latino (LAT)). We jointly analyzed genome-wide association studies (GWAS) of HIV-1 viral load from EUR, AA and LAT populations. Our analysis pinpointed the MHC association to three amino acid positions (97, 67 and 156) marking three consecutive pockets (C, B and D) within the HLA-B peptide binding groove, explaining 12.9% of trait variance, and obviating effects of previously reported associations from population-specific HIV studies.

7: Outcomes among HIV-positive patients hospitalized with COVID-19
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Posted 12 May 2020

Outcomes among HIV-positive patients hospitalized with COVID-19
1,716 downloads medRxiv hiv aids

Savannah Karmen-Tuohy, Philip M. Carlucci, Ioannis M. Zacharioudakis, Fainareti N. Zervou, Gabriel Rebick, Elizabeth Klein, Jenna Reich, Simon Jones, Joseph Rahimian

Background: SARS-CoV-2 infection continues to cause significant morbidity and mortality worldwide. Preliminary data on SARS-CoV-2 infection suggests that some immunocompromised hosts experience worse outcomes. We performed a retrospective matched cohort study to characterize outcomes in HIV-positive patients with SARS-CoV-2 infection. Methods: Leveraging data collected from electronic medical records for all patients hospitalized at NYU Langone Health with COVID-19 between March 2, 2020 and April 23, 2020, we matched 21 HIV-positive patients to 42 non-HIV patients using a greedy nearest neighbor algorithm. Admission characteristics, laboratory results, and hospital outcomes were recorded and compared between the two groups. Results: While there was a trend toward increased rates of ICU admission, mechanical ventilation, and mortality in HIV-positive patients, these differences were not statistically significant. Rates for these outcomes in our cohort are similar to those previously published for all patients hospitalized with COVID-19. HIV-positive patients had significantly higher admission and peak CRP values. Other inflammatory markers did not differ significantly between groups, though HIV-positive patients tended to have higher peak values during their clinical course. Three HIV-positive patients had superimposed bacterial pneumonia with positive sputum cultures, and all three patients expired during hospitalization. There was no difference in frequency of thrombotic events or myocardial infarction between these groups. Conclusion: This study provides evidence that HIV coinfection does not significantly impact presentation, hospital course, or outcomes of patients infected with SARS-CoV-2, when compared to matched non-HIV patients. A larger study is required to determine if the trends we observed apply to all HIV-positive patients.

8: Risk of adverse COVID-19 outcomes for people living with HIV: a rapid review and meta-analysis
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Posted 23 Sep 2020

Risk of adverse COVID-19 outcomes for people living with HIV: a rapid review and meta-analysis
1,710 downloads medRxiv hiv aids

Maya Mellor, Anne Bast, Nicholas Jones, Nia Roberts, Jose Ordonez-Mena, Alastair Reith, Christopher C Butler, Philippa C Matthews, Jienchi Dorward

Objective: To assess whether people living with HIV (PLWH) are at increased risk of COVID-19 mortality or adverse outcomes, and whether antiretroviral therapy (ART) influences this risk. Design: Rapid review with meta-analysis and narrative synthesis. Methods: We searched databases including Embase, Medline, medRxiv, and Google Scholar up to 26th August 2020 for studies describing COVID-19 outcomes in PLWH and conducted a meta-analysis of higher quality studies. Results: We identified 1,908 studies and included 19 in the review. In a meta-analysis of five studies, PLWH had a higher risk of COVID-19 mortality (hazard ratio (HR) 1.93, 95% Confidence Interval (CI): 1.59-2.34) compared to people without HIV. Risk of death remained elevated for PLWH in a subgroup analysis of hospitalised cohorts (HR 1.54, 95% CI: 1.05-2.24) and studies of PLWH across all settings (HR 2.08, 95%CI: 1.69-2.56). Eight other studies assessed the association between HIV and COVID-19 outcomes, but provided inconclusive, lower-quality evidence due to potential confounding and selection bias. There were insufficient data on the effect of CD4+ T cell count and HIV viral load on COVID-19 outcomes. Eleven studies reported COVID-19 outcomes by ART-regimen. In the two largest studies, tenofovir-disoproxil-fumarate (TDF)-based regimens were associated with a lower risk of adverse COVID-19 outcomes, although these analyses are susceptible to confounding by comorbidities. Conclusion: Evidence is emerging that suggests a moderately increased risk of COVID-19 mortality amongst PLWH. Further investigation into the relationship between COVID-19 outcomes and CD4+ T cell count, HIV viral load, ART and the use of TDF is warranted.

9: COVID-19 and HIV co-infection: a living systematic evidence map of current research
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Posted 07 Jun 2020

COVID-19 and HIV co-infection: a living systematic evidence map of current research
1,466 downloads medRxiv hiv aids

Gwinyai Masukume, Witness Mapanga, Doreen Sindisiwe van Zyl

Abstract The world currently faces two ongoing devastating pandemics. These are the new severe acute respiratory syndrome coronavirus 2/coronavirus disease 2019 (SARS-CoV-2/COVID-19) and the prior human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) pandemics. The literature regarding the confluence of these global plagues expands at pace. A systematic search of the literature considering COVID-19 and HIV co-infection was performed. After five months, from the beginning of the COVID-19 pandemic, there were at least thirty-five studies reported from thirteen countries. These ranged from individual case reports and series to cohort studies. Based on studies that could be extrapolated to the general population, co-infected individuals with suppressed HIV viral loads did not have disproportionate COVID-19 sickness and death. At least four patients, newly diagnosed with HIV recovered from COVID-19. Current evidence suggests that co-infected patients should be treated like the general population. This ongoing living systematic evidence map of contemporary primary SARS-CoV-2 and HIV co-infection research provides a platform for researchers, policy makers, clinicians and others to more quickly discover and build relevant insights.

10: Casual sex among MSM during the period of social isolation in the COVID-19 pandemic: Nationwide study in Brazil and Portugal.
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Posted 09 Jun 2020

Casual sex among MSM during the period of social isolation in the COVID-19 pandemic: Nationwide study in Brazil and Portugal.
1,372 downloads medRxiv hiv aids

Alvaro Francisco Lopes de Sousa, Layze Braz Oliveira, Guilherme Schneider, Artur Acelino Francisco Luz Queiroz, Herica Emilia Felix de Carvalho, Telma Maria Evangelista de Araujo, Emerson Lucas Silva Camargo, Sandra Brignol, Isabel Amelia Costa Mendes, Willi McFarland, InĂªs Fronteira

Background: The social isolation to which Brazilians and Portuguese are subjected has been affecting their mental and sexual health, decreasing social support and increasing sexual risk behavior and exposure to the SARSCoV-2 virus. In this study we aim to investigate the practice of casual sex and the factors that are associated with this event in the context of the COVID-19 pandemic. Methods: An online survey carried out throughout Brazil and Portugal in April 2020, during the period of social isolation, with a sample of 2361 MSM. The collection took place in meeting apps and Facebook. Findings: There was a high frequency of casual sex (53%) and the use of strategies, without technical or scientific basis, to prevent infection by SARSCoV-2, such as the use of Truvada (12.7%). Among the factors that increased the chance of engaging in casual sex, we highlight: having sex simultaneously with two or more people (aOR = 2.1; 95%CI 1.4 - 3.4); Having sex with a regular and casual partner (aOR = 1.6; 95% CI 0.9-2.8), and only with casual (aOR = 2.5; 95%CI 1.8 - 3.5), using Facebook (aOR = 4.6; 95%CI 3.0-7.2), and cruising, swing houses, saunas or cruising points to get partners (aOR = 5.4; 95%CI 3.2 -8.9), being HIV positive (ORa = 11.7; 95%CI 4.7-29.2), or of unknown serological status (aOR = 1.4; 95%CI 0.7-2.3). In both countries, the longer the period of social isolation, the greater the chance of engaging in casual sex. Interpretation: Despite the great differences between the two countries, in both of them we registered a significant frequency of practicing casual sex, accompanied by dubious strategies to minimize the risk of acquiring SARSCov-2. This indicates that MSM participating in the research, to some degree, continue to be exposed to risky sexual practices for HIV infection and other STIs, but also for COVID-19. Funding: Conselho Nacional de Pesquisa-CNPq, Brazil.

11: COVID-19 Vulnerability of Transgender Women With and Without HIV Infection in the Eastern and Southern U.S.
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Posted 24 Jul 2020

COVID-19 Vulnerability of Transgender Women With and Without HIV Infection in the Eastern and Southern U.S.
1,232 downloads medRxiv hiv aids

Tonia Poteat, Sari Reisner, Marissa Miller, AL Wirtz

Background: COVID-19 is a new global pandemic and people with HIV may be particularly vulnerable. Gender identity is not reported, therefore data are absent on the impact of COVID-19 on transgender people, including transgender people with HIV. Baseline data from the American Cohort to Study HIV Acquisition Among Transgender Women in High Risk Areas (LITE) Study provide an opportunity to examine pre-COVID vulnerability among transgender women. Setting: Atlanta, Baltimore, Boston, Miami, New York City, Washington, DC Methods: Baseline data from LITE were analysed for demographic, psychosocial, and material factors that may affect risk for COVID-related harms. Results: The 1020 participants had high rates of poverty, unemployment, food insecurity, homelessness, and sex work. Transgender women with HIV (n=273) were older, more likely to be Black, had lower educational attainment, and were more likely to experience material hardship. Mental and behavioural health symptoms were common and did not differ by HIV status. Barriers to healthcare included being mistreated mistreatment, uncomfortable providers, and past negative experiences; as well as material hardships, such as cost and transportation. However, most reported access to material and social support - demonstrating resilience. Conclusions: Transgender women with HIV may be particularly vulnerable to pandemic harms. Mitigating this harm would have positive effects for everyone, given the highly infectious nature of this coronavirus. Collecting gender identity in COVID-19 data is crucial to inform an effective public health response. Transgender-led organizations' response to this crisis serve as an important model for effective community-led interventions.

12: Outcomes of COVID-19 related hospitalisation among people with HIV in the ISARIC WHO Clinical Characterisation Protocol UK Protocol: prospective observational study
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Posted 11 Aug 2020

Outcomes of COVID-19 related hospitalisation among people with HIV in the ISARIC WHO Clinical Characterisation Protocol UK Protocol: prospective observational study
1,188 downloads medRxiv hiv aids

Anna Maria Geretti, Alexander Stockdale, Sophie Kelly, Muge Cevik, Simon Collins, Laura Waters, Giovanni Villa, Annemarie B Docherty, Ewen M Harrison, Lance Turtle, Peter JM Openshaw, J Kenneth Baillie, Caroline Sabin, Malcolm Gracie Semple

Background. There is conflicting evidence about how HIV infection influences COVID-19. We compared the presentation characteristics and outcomes of people with and without HIV hospitalised with COVID-19 at 207 centres across the United Kingdom. Methods. We analysed data from people with laboratory confirmed or highly likely COVID-19 enrolled into the ISARIC CCP-UK study. The primary endpoint was day-28 mortality after presentation. We used Kaplan-Meier methods and Cox regression to describe the association with HIV status after adjustment for sex, ethnicity, age, indeterminate/probable hospital acquisition of COVID-19 (definite hospital acquisition excluded), presentation date, and presence/absence of ten comorbidities. We additionally adjusted for disease severity at presentation as defined by hypoxia/oxygen therapy. Findings. Among 47,539 patients, 115 (0.24%) had confirmed HIV-positive status and 103/115 (89.6%) had a record of antiretroviral therapy. At presentation, relative to the HIV-negative group, HIV-positive people were younger (median 55 versus 74 years; p<0.001), had a higher prevalence of obesity and moderate/severe liver disease, higher lymphocyte counts and C-reactive protein, and more systemic symptoms. The cumulative incidence of day-28 mortality was 25.2% in the HIV-positive group versus 32.1% in the HIV-negative group (p=0.12); however, stratification for age revealed a higher mortality among HIV-positive people aged below 60 years. The effect of HIV-positive status was confirmed in adjusted analyses (adjusted hazard ratio [HR] 1.49, 95% confidence interval [CI] 0.99-2.25; p=0.06). Following additional adjustment for disease severity at presentation, mortality was higher in HIV-positive people (adjusted HR 1.63; 95% CI 1.07-2.48; p=0.02). In the HIV-positive group, mortality was more common among those who were slightly older and among people with obesity and diabetes with complications. Interpretation. HIV-positive status may be associated with an increased risk of day-28 mortality following a COVID-19 related hospitalisation.

13: Does the early nutritional environment and in utero HIV exposure, in the absence of infant infection, impact infant development?
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Posted 12 Aug 2019

Does the early nutritional environment and in utero HIV exposure, in the absence of infant infection, impact infant development?
1,131 downloads medRxiv hiv aids

Marina White, Eleanor Duffley, Ute D. Feucht, Theresa Rossouw, Kristin L. Connor

Malnutrition and infectious disease often coexist in socially inequitable contexts. Malnutrition in the perinatal period adversely affects offspring development and lifelong non-communicable disease risk. Less is known about the effects of infectious disease exposure during critical windows of development and health, and links between in utero HIV-exposure in the absence of neonatal infection, perinatal nutritional environments, and infant development are poorly defined. In a pilot feasibility study at Kalafong Hospital, Pretoria, South Africa, we aimed to better understand relationships between maternal HIV infection and the early nutritional environment of in utero HIV exposed uninfected (HEU) infants. We also undertook exploratory analyses to investigate relationships between food insecurity and infant development. Mother-infant dyads were recruited after delivery and followed until 12 weeks postpartum. Household food insecurity, nutrient intakes and dietary diversity scores did not differ between mothers living with or without HIV. Maternal reports of food insecurity were associated with lower maternal nutrient intakes 12 weeks postpartum, and in infants, higher brain-to-body weight ratio at birth and 12 weeks of age, and attainment of fewer large movement and play activities milestones at 12 weeks of age, irrespective of maternal HIV status. Reports of worry about food runout were associated with increased risk of stunting for HEU, but not unexposed, uninfected infants. Our findings suggest that food insecurity, in a vulnerable population, adversely affects maternal nutritional status and infant development. In utero exposure to HIV may further perpetuate these effects, which has implications for early child development and lifelong human capital.

14: Elevated COVID-19 outcomes among persons living with diagnosed HIV infection in New York State: Results from a population-level match of HIV, COVID-19, and hospitalization databases
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Posted 06 Nov 2020

Elevated COVID-19 outcomes among persons living with diagnosed HIV infection in New York State: Results from a population-level match of HIV, COVID-19, and hospitalization databases
1,111 downloads medRxiv hiv aids

James M Tesoriero, Carol-Ann E. Swain, Jennifer L. Pierce, Lucila Zamboni, Meng Wu, David R Holtgrave, Charles J. Gonzalez, Tomoko Udo, Johanne E. Morne, Rachel Hart-Malloy, Deepa T. Rajulu, Shu-Yin John Leung, Eli S Rosenberg

BackgroundNew York State (NYS) has been an epicenter for both COVID-19 and HIV/AIDS epidemics. Persons Living with diagnosed HIV (PLWDH) may be more prone to COVID-19 infection and severe outcomes, yet few population-based studies have assessed the extent to which PLWDH are diagnosed, hospitalized, and have died with COVID-19, relative to non-PLWDH. MethodsNYS HIV surveillance, COVID-19 laboratory confirmed diagnoses, and hospitalization databases were matched. COVID-19 diagnoses, hospitalization, and in-hospital death rates comparing PLWDH to non-PLWDH were computed, with unadjusted rate ratios (RR) and indirect standardized RR (sRR), adjusting for sex, age, and region. Adjusted RR (aRR) for outcomes among PLWDH were assessed by age/CD4-defined HIV disease stage, and viral load suppression, using Poisson regression models. ResultsFrom March 1-June 7, 2020, PLWDH were more frequently diagnosed with COVID-19 than non-PLWDH in unadjusted (RR [95% confidence interval (CI)]: 1.43[1.38-1.48), 2,988 PLWDH], but not in adjusted comparisons (sRR [95% CI]: 0.94[0.91-0.97]). Per-population COVID-19 hospitalization was higher among PLWDH (RR [95% CI]: 2.61[2.45-2.79], sRR [95% CI]: 1.38[1.29-1.47], 896 PLWDH), as was in-hospital death (RR [95% CI]: 2.55[2.22-2.93], sRR [95%CI]: 1.23 [1.07-1.40], 207 PLWDH), albeit not among those hospitalized (sRR [95% CI]: 0.96[0.83-1.09]). Among PLWDH, hospitalization risk increased with disease progression from HIV Stage 1 to Stage 2 (aRR [95% CI]:1.27[1.09-1.47]) and Stage 3 (aRR [95% CI]: 1.54[1.24-1.91]), and for those virally unsuppressed (aRR [95% CI]: 1.54[1.24-1.91]). ConclusionPLWDH experienced poorer COVID-related outcomes relative to non-PLWDH, with 1-in-522 PLWDH dying with COVID-19, seemingly driven by higher rates of severe disease requiring hospitalization.

15: Prevalence of malnutrition and associated factors among adult patients on Antiretroviral Therapy follow up care in Jimma Medical Center, Southwest Ethiopia.
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Posted 05 Nov 2019

Prevalence of malnutrition and associated factors among adult patients on Antiretroviral Therapy follow up care in Jimma Medical Center, Southwest Ethiopia.
1,093 downloads medRxiv hiv aids

Dawit Wolde Daka, Meskerem Seboka Ergiba

BackgroundMalnutrition especially under nutrition is the main problem that is seen over people living with HIV/AIDS and can occur at any age. Multiple factors contributed to malnutrition of HIV/AIDS patients and it need immediate identification and prompt action. The objective of this study was to assess the nutritional status of patients and identify factors associated with malnutrition among HIV/AIDS patients on follow-up care in Jimma medical center, Southwest Ethiopia. MethodsA cross-sectional study design was conducted from March-April, 2016. Data was collected retrospectively from clinical records of HIV/AIDS patients enrolled for follow up care in ART clinic from June 2010 to January 2016. Binary and multiple variable logistic regression was done to identify independent predictor of malnutrition. ResultsData of 971 patients were included in the study. The prevalence of under nutrition (BMI<18.5) was (36.8%) (95% CI: 33.8%-39.8%) and out of which severe malnutrition accounts 9.7%. Overweight and obese was 8.6%. Malnutrition was more likely among widowed patients (AOR=1.7, 95% CI, 1.034-2.798), patients in the WHO clinical AIDS staging of three (AOR=2.3, 95% CI, 1.392-3.693) and four (AOR=3.2, 95% CI, 1.667-5.943), patients with CD4 cell count of <200 cells/mm3 (AOR=2.0, 95% CI, 1.463-2.837) and patients with a functional status of bedridden (AOR=4.677, 95% CI, 1.761-12.419) and ambulatory (AOR=2.763, 95% CI, 1.833-4.165). ConclusionBoth under nutrition and overweight are prevalent among HIV/AIDS patients in Jimma Medical Center, Ethiopia. Malnutrition was significantly associated with clinical outcome of patients. Hence, nutritional assessment, care and support should be strengthened. Critical identification of malnourished patients and prompt interventions should be undertaken.

16: Prevalence, clinical characteristics and treatment outcomes of HIV and SARS-CoV-2 co-infection: a systematic review and meta-analysis
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Posted 03 Jun 2020

Prevalence, clinical characteristics and treatment outcomes of HIV and SARS-CoV-2 co-infection: a systematic review and meta-analysis
998 downloads medRxiv hiv aids

Joseph Baruch Baluku, Ronald Olum, Curthbert Agolor, Josephine Nakakande, Laura Russell, Felix Bongomin, Jane Nakaweesi

Objectives: To determine the prevalence, clinical characteristics and outcomes of HIV and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) co-infection. Methods: We searched Medline, Embase, Cochrane and Web of Science databases and grey literature for studies reporting epidemiological and clinical data of patients with HIV and SARS-CoV-2 co-infection. Eligible studies were all observational or interventional studies and commentaries in English language that reported patient data on HIV/SARS-CoV-2 co-infection. We used random effect meta-analysis to determine the pooled prevalence and mortality. Results: Of the 17 eligible studies, there were 3 retrospective cohorts, 1 survey, 5 case series, 7 case reports and 1 commentary that reported on a total of 146 HIV infected individuals. The pooled prevalence of HIV among individuals with SARS-CoV-2 infection was 1.0% (95% CI: 0.0 - 3.0, I2 = 79.3%, p=0.01), whereas the prevalence of SARS-CoV-2 among HIV patients was 0.68% (95% CI: 0.34 - 1.34). There were 110 (83.8%) HIV/ SARS-CoV-2 co-infected males, and the age (range) of the co-infected was 30 - 60 years. A total of 129 (97.0%) were anti-retroviral therapy experienced, and 113 (85.6%) had a suppressed HIV viral load. The CD4 count (range) was 298 - 670 cells/mm3 (n = 107). The commonest symptoms were fever (73.5%, n=75) and cough (57.8%, n = 59). Sixty-two (65.3%) patients had at least one other comorbid condition, of which hypertension (26.4%, n = 38) was the commonest. Chest radiological imaging abnormalities were found in 46 (54.1%) cases. Twenty-eight cases (56.0%) were reported as mild. Recovery occurred in 120 (88.9%) cases, and the pooled mortality was 9% (95% CI: 3.0 - 15.0, I2 = 25.6%, p =0.24). Conclusion: The prevalence of HIV/SARS-CoV-2 co-infection was low. The clinical characteristics and outcomes of HIV/SARS-CoV-2 co-infection are comparable to those reported among HIV negative SARS-CoV-2 cases.

17: Prevalence of HIV in patients hospitalized for COVID-19 and associated outcomes: a systematic review and meta-analysis
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Posted 06 Jul 2020

Prevalence of HIV in patients hospitalized for COVID-19 and associated outcomes: a systematic review and meta-analysis
996 downloads medRxiv hiv aids

Paddy Ssentongo, Emily S. Heilbrunn, Anna E Ssentongo, Shailesh Advani, Vernon M. Chinchilli, Jonathan J Nunez, Ping Du

Objective To conduct a systematic review and meta-analysis of the prevalence of HIV in patients hospitalized for COVID-19 and delineating clinical outcomes including mortality. Design/Methods MEDLINE, SCOPUS, OVID, and Cochrane Library databases and medrxiv.org were searched from January 1st, 2020, to June 15th, 2020. Data were extracted from studies reporting the prevalence of HIV among hospitalized COVID-19 patients and their clinical outcomes. Analyses were performed using random-effects models on log-transformed proportions and risk ratio estimates, and heterogeneity was quantified. Results A total of 144,795 hospitalized COVID-19 patients were identified from 14 studies in North America, Europe, and Asia. Median age was 55 years, and 66% were male. The pooled prevalence of HIV in COVID-19 patients was 1.22% [95% confidence interval (CI): 0.61%-2.43%)] translating to a 2-fold increase compared to the respective local-level pooled HIV prevalence in the general population of 0.65% (95% CI: 0.48%-0.89%). When stratified by country, the pooled HIV prevalence among COVID-19 patients in United States (1.43%, 95% CI: 0.98%-2.07%) was significantly higher compared to Spain (0.26%, 95% CI: 0.23%-0.29%) but was not different from China (0.99%, 95% CI: 0.25%-3.85%). The pooled mortality rate in HIV-positive patients hospitalized for COVID-19 was 14.1% (95% CI: 5.78%-30.50%) and was substantially higher in the United States compared to other countries.

18: COVID-19 among people living with HIV: A systematic review
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Posted 14 Jul 2020

COVID-19 among people living with HIV: A systematic review
901 downloads medRxiv hiv aids

Hossein Mirzaei, Willi McFarland, Mohammad Karamouzian, Hamid Sharifi

This systematic review summarizes the evidence on the earliest patients with COVID-19-HIV co-infection. We searched PubMed, Scopus, Web of Science, Embase, preprint databases, and Google Scholar from December 01, 2019 to June 1, 2020. From an initial 547 publications and 75 reports, 25 studies provided specific information on COVID-19 patients living with HIV. Studies described 252 patients, 80.9% were male, mean age was 52.7 years, and 98% were on ART. Co-morbidities in addition to HIV and COVID-19 (multimorbidity) included hypertension (39.3%), obesity or hyperlipidemia (19.3%), chronic obstructive pulmonary disease (18.0%), and diabetes (17.2%). Two-thirds (66.5%) had mild to moderate symptoms, the most common being fever (74.0%) and cough (58.3%). Among patients who died, the majority (90.5%) were over 50 years old, male (85.7%), and had multimorbidity (64.3%). Our findings highlight the importance of identifying co-infections, addressing co-morbidities, and ensuring a secure supply of ART for PLHIV during the COVID-19 pandemic.

19: Chloroquine Administration in Breastfeeding Mothers Associates with Increased HIV-1 Plasma Viral Loads
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Posted 05 May 2020

Chloroquine Administration in Breastfeeding Mothers Associates with Increased HIV-1 Plasma Viral Loads
849 downloads medRxiv hiv aids

William A Paxton, Marloes A Naarding, Ferdinand WNM WNM Wit, Nienke J Veldhuijzen, Matthew F Chersich, Brigitte Kankindi Kankindi, Rene Douma A Douma, Samuel Tuyizere, Suzanne Jurriaans, Rolf W Sparidans, Jos H Beijnen, Georgios Pollakis, Johan R Boelaert, Joep MA Lange, Joseph Vyankandondera, Stanley Luchters

Chloroquine (CQ) and Hydroxychloroquine (HCQ) have been proposed to be effective at treating COVID-19 patients. We, and others, have previously reported on the capacity of CQ to reduce HIV-1 replication in vitro. We tested CQ administration in post-partum mothers on influencing HIV-1 viral loads in human milk as a means of lowering mother to child transmission. A Phase I/II, randomized, placebo-controlled study to evaluate chloroquine administration to reduce HIV-1 RNA levels in human milk: the CHARGE study. Thirty HIV-1 positive pregnant Rwandese women (CQ n = 20; placebo n = 10) were enrolled in a 16-week study, with the treatment group receiving a 200 mg oral dose of CQ daily. Base-line plasma viral load (pVL) measurements and CD4 counts were determined prior to delivery, and pVL, breast milk VL (bmVL) and CQ levels measured during treatment. For women receiving treatment, CQ concentration was higher in breast milk compared to plasma (over 2.5-fold), with a positive correlation between the levels in the two compartments (P < 0.003). A link between high CQ concentrations in plasma and high CD4 counts (P < 0.001) was observed. Surprisingly, we found a significant increase in pVL after CQ treatment in over half of the mothers (n=11; P < 0.001) and with no alteration to bmVL measurements. No specific amino acid alterations in the gp120 envelope sequences could be associated with CQ administration. CQ usage is associated with a significant increase to pVL in early breastfeeding mothers from Rwanda which cautions against the use of CQ in such individuals. Our results highlight a discrepancy between CQ effects on modulating HIV-1 replication in vitro versus in vivo and indicate caution when prescribing CQ to post-partum HIV-1 untreated mothers. This discrepancy should be taken into consideration when testing CQ or HCQ treatment in COVID-19 clinical trials, especially relating to the post-partum setting.

20: Does in utero HIV-exposure influence infant development and immune outcomes? Findings from a pilot study in Pretoria, South Africa.
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Posted 20 Sep 2019

Does in utero HIV-exposure influence infant development and immune outcomes? Findings from a pilot study in Pretoria, South Africa.
815 downloads medRxiv hiv aids

Marina White, Ute D. Feucht, Eleanor Duffley, Felicia Molokoane, Chrisna Durandt, Edana Cassol, Theresa Rossouw, Kristin L. Connor

BackgroundAs mother-to-child-transmission of HIV decreases, and the population of infants who are born HIV-exposed, but uninfected (HEU) continues to rise, there is growing need to understand the development and health outcomes of infants who are HEU to ensure that they have the healthiest start to life. MethodsIn a prospective cohort pilot study at Kalafong Hospital, Pretoria, South Africa, we aimed to determine if we could recruit new mothers living with HIV on antiretrovirals (ART; n=20) and not on ART (n=20), and new mothers without HIV (n=20) through our clinics to study the effects of HEU on growth, immune- and neuro-development in infants in early life, and test the hypothesis that infants who were HEU would have poorer health outcomes compared to infants who were HIV-unexposed, uninfected (HUU). We also undertook exploratory analyses to investigate relationships between the early nutritional environment, food insecurity, and infant development. Infant growth, neurodevelopment (Guide for Monitoring Child Development [GMCD]) and levels of monocyte subsets (CD14, CD16, and CCR2 expression [flow cytometry]) were measured in infants at birth and 12 weeks (range 8-16 weeks). ResultsWe recruited 33 women living with HIV on ART, and 22 women living without HIV within four days of delivery from June-December 2016. 21 women living with HIV and 10 without HIV returned for a follow-up appointment at 12 weeks postpartum. The high mobility of this population presented major challenges to participant retention. Preliminary analyses revealed lower head circumference and elevated CCR2+ (% and median fluorescence intensity) on monocytes at birth among infants who were HEU compared to HUU. Maternal reports of food insecurity were associated with lower maternal nutrient intakes at 12 weeks postpartum and increased risk of stunting at birth for infants who were HEU, but not infants who were HUU. ConclusionsOur small feasibility pilot study suggests that HEU may adversely affect infant development, and further, infants who are HEU may be even more vulnerable to the programming effects suboptimal nutrition in utero and postnatally. This pilot and preliminary analyses have been used to inform our research questions and protocol in our ongoing, full-scale study.

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