Previously Diagnosed HIV Infection in Patients with COVID-19 and Advanced HIV Disease Improves Their Survival

Abstract

Background: Currently, the global HIV epidemic remains ongoing, with a significant number of patients having undiagnosed advanced HIV disease. Providing medical care to patients with both COVID-19 and advanced HIV disease presents specific challenges due to the simultaneous lung damage caused by the SARS-CoV-2 virus and opportunistic pathogens. Objectives: This study aimed to explain the rationale behind recommending HIV screening for patients with severe COVID-19. Methods: A single-center retrospective cohort study was conducted using electronic medical records from a specialized hospital in Moscow that focused on coinfection with HIV/COVID-19. Among the 3,563 patients hospitalized in the relevant departments during the study period, 408 patients were included based on the inclusion/exclusion criteria. Out of the 408 patients with both COVID-19 and advanced HIV disease, 132 individuals were newly diagnosed with HIV infection, while 276 individuals had a previously established HIV diagnosis. Results: The mortality rate in the group of patients with COVID-19 and advanced HIV disease was 31.7% (95% CI, 27.3 - 36.3%). Among patients with COVID-19 and newly diagnosed advanced HIV disease, the mortality rate was 45.5% (95% CI, 37.1 - 54%), while in the group of patients with previously diagnosed advanced HIV disease, the mortality rate was 25% (95% CI, 20.2 - 30.4%). The proportion of individuals with critical CT-4 lung disease in the first group was 32.3% compared to 9.4% in the second group (P < 0.001). The median CD4+ count was 20 cells/µL in the first group compared with 88 cells/µL in the second group (P < 0.001). Conclusions: The presence of pneumocystis pneumonia increased the risk of death by 2.51 times in patients with COVID-19 and newly diagnosed advanced HIV disease. Additionally, Kaposi's sarcoma increased the risk of death by 1.31 times in the same patient group. Furthermore, the detection of HIV infection for the first time during hospitalization due to COVID-19 in the entire study cohort increased the risk of death by 2.21 times.