Clinical characteristics of the course of COVID-19 on the background of HIV infection, depending on the outcome of hospitalization

The combined course of the COVID-19 and the human immunodeficiency virus infection (HIV) has attracted the attention of researchers since the advent of COVID-19 due to the unpredictable course of the new disease in patients with immunosuppression.
Objective: To study the clinical and laboratory profile of patients with co-infection of HIV and COVID-19 based on disease outcomes.
Materials and methods: A retrospective analysis was conducted on the medical records of 310 HIV-infected patients admitted for COVID-19 treatment at the S.P. Botkin Clinical Infectious Diseases Hospital between 2020 and 2021. The first patients admitted to the hospital, whose hospitalization ended in death (n=147, 48%) and the first patients discharged after recovery from COVID-19 (n=163, 52%) were selected.
Results: At the onset of the pandemic, the infectious disease hospital admitted predominantly young patients (median (Q25; Q75) – 41 (37; 46) years), male (66%), with advanced stages of HIV infection (2B – 0.4%, 3 – 4.8%, 4A – 17.9%, 4B – 7.7%, 4C – 69.2%), not on antiretroviral therapy (73%), with low CD4+ T-lymphocyte counts (median (Q25; Q75) – 34 (7; 130) cells/mL), high HIV viremia (median(Q25; Q75) – 127,516 (1,568; 593,661) copies/mL), and the presence of current opportunistic infections (88%) and viral hepatitis (58%). Deceased patients were more frequently male (72% vs. 62%, χ2=4.935, p=0.026), admitted at later stages of COVID-19 (median (Q25; Q75) – 9 (2; 22) vs. 2 (1; 8) days, p<0.001), with predominantly severe disease progression (mild – 2%, moderate – 37%, severe – 53%, critical – 8% vs. mild – 21%, moderate – 79%, p<0.001), and died at a median of 12 days (median (Q25; Q75) – 12 (6; 25) days).
Among deceased patients, substance dependence (35% vs. 16%, p<0.001) and alcohol abuse (23% vs. 10%, p=0.003) were more common, as were complications such as pneumonia (62% vs. 43%, p=0.001), along with neurological, respiratory, cardiovascular, digestive, and genitourinary system involvement. Deceased patients exhibited more pronounced immunological abnormalities, higher HIV viremia, worse liver and kidney function markers, and more severe inflammatory changes in laboratory tests. The severity of COVID-19 was inversely correlated with absolute CD4+ T-lymphocyte counts (Spearman’s r = -0.278, p<0.001).
Conclusion: HIV-infected patients with COVID-19 who died during hospitalization were primarily admitted in severe or critical condition and were characterized by uncontrolled HIV progression due to lack of antiretroviral therapy, as well as substance and alcohol dependence.

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