COVID‐19 in three people living with HIV in the United Kingdom

Abstract

We would like to report the clinical characteristics of three people living with HIV (PLWH) in the United Kingdom within the context of coronavirus disease-2019 (COVID-19). Our institution serves a population of 500 000 with a prevalence of HIV at 0.34%. At of the time of writing, 5th June 2020, only three PLWH tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on nasopharyngeal swab specimen using real-time reverse transcriptase-polymerase chain reaction have required admission to hospital. These account for 0.43% of total COVID-19 admissions to our hospital where the overall mortality rate is currently 27%. There are scarce data available on PLWH and COVID-19 and although our case series is small, it may be relevant. We treated three Black patients: two male and one female. One male patient required intubation soon after admission and died in the intensive care unit (ITU) while the other two patients required continuous positive airway pressure and were subsequently discharged in a good condition. Preadmission CD4 counts varied from 50/mm3 to 890/mm3 and each patient was prescribed different antiretroviral therapy (ART) regimens, none of which contained lopinavir-ritonavir. Two of the regimens contained tenofovir which has theoretical antiviral activity.1, 2 They all remained on preadmission ART regimens in accordance with guidance from the British HIV Association.3 Patient 1 was a 62-year-old polymorbid Nigerian male with risk factors for poor outcomes in COVID-19. He had received a renal transplant, was immunocompromised from tacrolimus and mycophenolate treatment, and also had type 2 diabetes (T2DM) and hypertension. He was intubated and ventilated on ITU and died from multiorgan failure precipitated by COVID-19 pneumonitis. A high mortality rate has been associated with transplant patients infected with COVID-19 who require hospitalization4 and this, alongside other comorbidities, all of which are cited as poor prognostic markers, likely contributed to death rather than HIV status. Patient 2, a 46-year-old Jamaican male with glucose-6-phosphate dehydrogenase (G6PD) deficiency, had been ART naïve until 5 days before admission after he had been lost to follow-up since diagnosis in 2013. With a CD4 count of 50/mm3 and a viral load more than 1 million/mL, in the setting of COVID-19 infection, it was felt likely he had added Pneumocystis carinii pneumonia and this was later supported by positive serum beta-d-glucan. He was treated with atovaquone in view of G6PD deficiency and had a good outcome. Patient 3, a 57-year-old Zimbabwean female with a history of stroke, T2DM, hypertension, and obesity, was a nurse in an older persons care home with confirmed COVID-19 infections at the time of admission. She also was covered for added bacterial infection and was discharged in a good condition (Table 1). We suggest that HIV alone does not result in amplified risk of infection or adverse outcomes in COVID-19 infection when compared with the general population. This is supported by case series from both Germany and America, where no excess morbidity or mortality was found among patients with HIV.5, 6 Furthermore, Karmen-Tuohy et al7 compared a cohort of HIV-positive patients to a matched non-HIV cohort and concluded that HIV coinfection did not significantly impact presentation, hospital course or long-term outcomes. Patient 2 of our series, who in retrospect fulfilled AIDS defining criteria, did not suffer a more severe disease course—the assumption being that even these patients are not necessarily at heightened risk. As HIV is seen in an increasingly aging population, these patients may have comorbidities which independently augment the risk of adverse outcomes, and therefore, any conclusions drawn should be cautious. We postulate that patients with HIV may even be somewhat protected if established on ART.8 All of the above hypotheses need to be validated by further research with greater patient numbers. The authors received no specific funding for this study. The authors declare that there are no conflict of interests.

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