HIV and COVID-19 |
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Patient 1 |
Patient 2 |
Patient 3 |
Patient 4 |
Patient 5 |
Patient 6 |
Patient 7 |
|
Demographics and Baseline HIV status |
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Age (years) |
38 |
49 |
47 |
50 |
53 |
54 |
56 |
Race |
Hispanic |
African American |
Hispanic |
Caucasian |
Caucasian |
Caucasian |
Caucasian |
Gender |
Male |
Feale |
Male |
Male |
Male |
Male |
Male |
HIV risk factor, COVID-19 Exposure |
MSM, Uknown |
Heterosexual, Uknown |
MSM, Partner COVID + Exposure |
Unknown, Hospital Employee |
MSM, Partner COVID + Exposure |
MSM, Unknown |
MSM, Uknown |
Comorbidities (HTN,DM,cancer, smoking, immunosuppression, chronic inflammatory diseases, cardiac conditions) |
Kaposi Sarcoma on chemotherapy |
GERD, Obesity |
Tobacco Smoker |
T2DM, Moderate persistant asthma |
Melanoma, HTN |
Former Smoker, T2DM, HTN |
Kaposi Sarcoma, Syphilis, Hepatitis C |
HIV status (values at or before COVID-19 dx) |
Positive |
Positive |
Positive |
Positive |
Positive |
Positive |
Positive |
Year of HIV diagnosis |
2018 |
2002 |
2015 |
2000 |
1999 |
2001 |
2007 |
CD4 Cell count (cells per μL) |
30 |
173 |
1,178 |
29.8 |
628 |
328 |
874 |
CD4:CD8 ratio |
0.1 |
0.2 |
1.5 |
0.8 |
0.7 |
0.4 |
0.8 |
HIV viral load at or beore admission (copeis per mL) |
517 |
Not Detected, <40 |
Not Detected, <40 |
Not Detected, <40 |
Not Detected, <40 |
Not Detected, <40 |
Not Detected, <40 |
ART- regimen before admission |
(Biktarvy)BIC/FTC/TAF, Atovaquone |
(Biktarvy)BIC/FTC/TAF |
(Descovy) FTC/TAF, (Tivicay) DTG |
(Triumeq) ABC / DTG / 3TC |
(Biktarvy)BIC/FTC/TAF |
(Genvoya) EVG/COBI/FTC/TAF |
(Genvoya) EVG/COBI/FTC/TAF |
BMI |
23.57 |
35.1 |
30.1 |
27.5 |
35 |
41.3 |
26.1 |
Duration of Symptoms (Days) |
6 |
6 |
Uknown |
25 |
49 |
29 |
25 |
COVID-19 Diagnosis |
4/29/20 |
5/19/20 |
6/30/20 |
4/13/20 |
5/15/20 |
5/13/20 |
6/26/20 |
Symptoms and Vital signs |
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Temperature |
103 °F |
100.3 °F |
n/a |
100.2 °F |
98 °F |
96.2 °F |
98.2 °F |
Symptoms |
Nausea, chills, and night sweats |
Fever, chills, myalgia, headache, cough, chest pressure, loss of appetite, vomiting after eating or drinking |
Fever, fatigue, sore throat, intermittent cough, and generalized body aches |
Fever, chills, cough (productive), and Shortnes of breath |
Pleuritic chest pain |
Fatigue, congestion, rhinorrhea, cough, wheezing, weakness, headache, decreased concentration, and increased sleep |
Fever, chills, congestion, cough (non-productive), diaphoresis, fatigue, and lack of smell (chronic) |
Blood pressure (mm Hg) |
136/72 |
150/82 |
n/a |
116/78 |
n/a |
112/64 |
132/88 |
Respiratory Rate (breaths per min) |
20 |
n/a |
n/a |
22 |
16 |
16 |
n/a |
Heart Rate (beats per min) |
118 |
95 |
n/a |
108 |
71 |
96 |
68 |
Chest X-Ray (CXR) findings or CT chest w/out contrast |
CXR:No radiographic evidence of cardiopulmonary findings |
n/a |
CXR: No active chest disease |
CT chest w/out contrast: Patchy foci of ground glass opacities scattered throughout lungs most pronounced in bilateral lower lobes, representing infectious process. Multifocal Pneumonia |
n/a |
CXR: No acute cardiopulmonary abnormality |
CXR: Cardiac silhouette and pulmonary vasculature are normal. No edema or infiltrate. There is a granuloma in the right lung base and left upper lobe. Minor nodularity in the right apex is also unchanged from 2018. |
O2 Saturation on room air |
99% |
95% |
ND |
98% |
88% |
96% |
97% |
PaO2/FiO2 ratio |
n/a |
452 |
n/a |
n/a |
n/a |
n/a |
n/a |
Laboratory Results |
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White blood cell count (k/ul) |
15.1 |
ND |
ND |
3.6 |
ND |
ND |
ND |
Abs Lymptocyte (k/ul) |
1.1 |
ND |
ND |
1.3 |
ND |
ND |
ND |
Platelets (k/ul) |
88 |
ND |
ND |
113 |
ND |
ND |
ND |
LDH (U/L) |
278 |
ND |
ND |
176 |
ND |
ND |
ND |
C-reactive protein (mg/dL) |
41.9 |
ND |
ND |
27.3 |
ND |
ND |
ND |
D-dimer (ng/mL) |
0.9 |
ND |
ND |
0.34 |
ND |
ND |
ND |
Ferritin (ng/mL) |
452 |
ND |
ND |
314 |
ND |
ND |
ND |
Procalcitonin (ng/mL) |
0.55 |
ND |
ND |
<0.05 |
ND |
ND |
ND |
Severity of the infection at admission (mild/mod/severe) |
Mild |
Mild |
Mild |
Moderate/Severe |
Mild |
Mild |
Moderate |
ART ( mention the full regimen) |
ART at admission maintained |
Not admitted inpatient but continued on ART therapy |
Not admitted inpatient but continued on ART therapy |
ART at admission maintained |
Not admitted inpatient but continued on ART therapy |
Not admitted inpatient but continued on ART therapy |
Not admitted inpatient but continued on ART therapy |
Other antiviral treatments |
None |
None |
None |
None |
None |
None |
None |
Other antibiotics |
Vancomycin, Cefepime, Flagyl, Fluconazole/Miconazole (14 days), Cefdinir (7 days), Doxycycline (7 days) |
None |
None |
Vancomycin, Zosyn, Azithromycin (5 days), Hydroxychloroquine (5 days) |
None |
Azithromycin |
Ceftriaxone, Doxycycline, Azithromycin |
Admitted to intesive care unit |
No |
No |
No |
No |
No |
No |
No |
Invasive or non-invasive ventilation |
No |
No |
No |
No |
No |
No |
No |
Corticosteroids or Tocilizumab |
No |
No |
No |
Methylprednisolone 40mg IV once then Prednisone 40mg (5days) |
No |
Triamcinolone Acetonide 40mg IM once |
No |
Length of hospital stay (days) |
4 |
0 |
0 |
6 |
0 |
0 |
0 |
Length of home quarantine (days) |
14 |
14 |
14 |
10 |
14 |
14 |
14 |
Outcomes |
Discharged home |
Discharged home |
Unknown |
Discharged home |
Discharged home |
Discharged home |
Discharged home |
Repeat COVID19 Testing done |
No |
No |
No |
Yes, after 5 months negative |
No |
No |
No |
Seen in hospital for admission within 30,60,90 days |
2 ED visits after 60 days for rash and skin abcesses |
Seen in ED after a month for constipation. No respiratory symtoms |
Seen by PCP after 2 weeks having air hunger and productive cough, improved by the end of 1 month |
Required 2 rounds of antibiotics for Bronchitis with doxycyline and Levaquin, continue to have shortnes of breath till about 58 days out from diagnosis |
Required albuterol inhaler for 2 months to help breath better |
No |
No |
Table 1a: Demographics, clinical characteristics at admission, treatment and outcomes of 7 patients with HIV & COVID-19 of hospitalized and clinic patients
COVID-19 - Coronavirus disease 2019, MSM - Men who have sex with men, n/a – Not available, GERD - Gastroesophageal reflux disease, T2DM – Type 2 Diabetes Mellitus, ESRD – End Stage Renal Disease, HTN - Hypertension, HLD- Hyperlipidemia, BIC – Bictegravir, TAF - Tenofovir alafenamide, FTC – Emtricitabine, DTG – Dolutegravir, ABC – Abacavir, 3TC – Lamivudine, EVG – Elvitegravir, COBI – Cobicistat, ART – Antiretroviral therapy, LDH, ED-Emergency department, PCP – Primary care physician.
|
COVID-19 |
||||||
Patient 1 |
Patient 2 |
Patient 3 |
Patient 4 |
Patient 5 |
Patient 6 |
Patient 7 |
|
Demographics and Baseline HIV status |
|||||||
Age (years) |
38 |
39 |
45 |
50 |
53 |
53 |
59 |
Race |
African American |
Hispanic |
Asian |
Caucasian |
Caucasian |
Caucasian |
African American |
Gender |
Male |
Male |
Male |
Male |
Male |
Female |
Male |
HIV risk factor, COVID-19 Exposure |
n/a, Work |
n/a, unknown (Costco employ) |
n/a, unknown (work?) |
n/a, unknown |
n/a, waterfall tourist destination in Eastern Iowa |
n/a, unknown |
n/a, Works at Nebraska beef |
Comorbidities (HTN,DM,cancer, smoking, immunosuppression, chronic inflammatory diseases, cardiac conditions) |
HTN, DM, ESRD, Anemia, tobacco use, hx of alcohol abuse |
GERD, Hypertension, Severe sleep apnea |
None |
T2DM, HTN, HLD, Sleep apnea |
T2DM |
None |
None |
HIV status (values at or before COVID-19 dx) |
Presumed Negative |
Presumed Negative |
Presumed Negative |
Presumed Negative |
Presumed Negative |
Presumed Negative |
Presumed Negative |
Year of HIV diagnosis |
n/a |
n/a |
n/a |
n/a |
n/a |
n/a |
n/a |
CD4 Cell count (cells per μL) |
n/a |
n/a |
n/a |
n/a |
n/a |
n/a |
n/a |
CD4:CD8 ratio |
n/a |
n/a |
n/a |
n/a |
n/a |
n/a |
n/a |
HIV viral load at or beore admission (copeis per mL) |
n/a |
n/a |
n/a |
n/a |
n/a |
n/a |
n/a |
ART- regimen before admission |
n/a |
n/a |
n/a |
n/a |
n/a |
n/a |
n/a |
BMI |
23.61 |
47 |
23.9 |
36.6 |
39.7 |
30.1 |
23 |
Duration of Symptoms (Days) |
1 |
2 |
10 |
5 |
Several days |
n/a |
4 |
COVID-19 Diagnosis |
6/9/20 |
7/9/20 |
6/14/20 |
6/26/20 |
7/17/20 |
7/20/20 |
6/2/20 |
Symptoms and Vital signs |
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Temperature |
98.9 °F |
99.4 °F |
98.4 °F |
100.2 °F |
97.9 °F |
n/a |
99 °F |
Symptoms |
Dizzy and weak |
Fever and shotness of breath |
Fevers at night, cough, loss of taste, and loss of appetite |
Fever, sore throat, cough, and shortness of breath |
Fever, cough, clear rhinorrhea, mild posterior nasal drainage, mild fatigue, and subjective chills |
n/a |
Fevers, mild cough, fatigue, and myalgias |
Blood pressure (mm Hg) |
153/89 |
157/91 |
120/67 |
172/103 |
150/99 |
n/a |
168/124 |
Respiratory Rate (breaths per min) |
20 |
20 |
20 |
18 |
20 |
n/a |
20 |
Heart Rate (beats per min) |
84 |
98 |
67 |
94 |
102 |
n/a |
77 |
Chest X-Ray (CXR) findings or CT chest w/out contrast |
CXR:No acute cardiopulmonary process. No evidence of pulmonary tuberculosis |
CT angio Chest:Minimal diffuse interstitial prominence, suggests mild pulmonary congestion. Patchy opacities in the right perihilar region and possibly in the right lower lobe, may reflect multifocal pneumonia. Covid pneumonia should be excluded. |
CXR:Bilateral multifocal groundglass opacifications consistent with atypical pneumonia versus pleuritis. |
CXR:No acute cardiopulmonary process. |
n/a |
n/a |
n/a |
O2 Saturation on room air |
96% |
98% |
97% |
97% |
96% |
n/a |
95% |
PaO2/FiO2 ratio |
428 |
>500 |
>500 |
>500 |
>500 |
n/a |
>500 |
Laboratory Results |
|||||||
White blood cell count (k/ul) |
6.3 |
4.1 |
3.5 |
3.7 |
n/a |
n/a |
n/a |
Abs Lymptocyte (k/ul) |
1.1 |
0.8 |
0.7 |
1.3 |
n/a |
n/a |
n/a |
Platelets (k/ul) |
146 |
204 |
134 |
184 |
n/a |
n/a |
n/a |
LDH (U/L) |
n/a |
229 |
n/a |
n/a |
n/a |
n/a |
n/a |
C-reactive protein (mg/dL) |
n/a |
61 |
n/a |
n/a |
n/a |
n/a |
n/a |
D-dimer (ng/mL) |
n/a |
0.57 |
n/a |
n/a |
n/a |
n/a |
n/a |
Ferritin (ng/mL) |
n/a |
290 |
n/a |
n/a |
n/a |
n/a |
n/a |
Procalcitonin (ng/mL) |
n/a |
<0.05 |
n/a |
n/a |
n/a |
n/a |
n/a |
Severity of the infection at admission (mild/mod/severe) |
Mild |
Moderate |
Mild |
Mild |
Mild |
Mild |
Mild |
ART ( mention the full regimen) |
None |
None |
None |
None |
None |
None |
None |
Other antiviral treatments |
None |
None |
None |
None |
None |
None |
None |
Other antibiotics |
None |
Ceftrixone and Azithromycin |
None |
None |
None |
None |
None |
Admitted to intesive care unit |
No |
No |
No |
No |
No |
No |
No |
Invasive or non-invasive ventilation |
No |
No |
No |
No |
No |
No |
No |
Corticosteroids or Tocilizumab |
No |
Dexamethasone |
No |
1 dose of dexamethasone |
No |
No |
No |
Length of hospital stay (days) |
6 |
6 |
0 |
0 |
0 |
0 |
0 |
Length of home quarantine (days) |
n/a |
n/a |
n/a |
14 |
n/a |
n/a |
n/a |
Outcomes |
Discharged home |
Discharged home |
Discharged home from ED |
Discharged home from ED |
Discharged home from ED |
Only lab test |
Discharged home |
Repeat COVID19 Testing done |
Yes, outside facility noted to be postive for 1 month |
7/16/2020 & 11/9/2020 +ve |
No |
No |
No |
No |
Yes, 6/16/2020 negative |
Seen in hospital for admission within 30,60,90 days |
No |
No |
No |
No |
After 10 days admitted for 5 day and received Remdesivir and dexamethasone. |
No |
No |
Table 1b:Demographics, clinical characteristics at admission, treatment and outcomes of 7 patients with COVID-19 age matched cohort of hospitalized and clinic patients
COVID-19 - Coronavirus disease 2019, MSM - Men who have sex with men, n/a – Not available, GERD - Gastroesophageal reflux disease, T2DM – Type 2 Diabetes Mellitus, ESRD – End Stage Renal Disease, HTN - Hypertension, HLD- Hyperlipidemia, BIC – Bictegravir, TAF - Tenofovir alafenamide, FTC – Emtricitabine, DTG – Dolutegravir, ABC – Abacavir, 3TC – Lamivudine, EVG – Elvitegravir, COBI – Cobicistat, ART – Antiretroviral therapy, LDH, ED-Emergency department, PCP – Primary care physician.