Predictors of adverse outcome of COVID-19 in hospitalized patients with HIV infection

Abstract

Introduction: Identifying the interaction between HIV-infection and death from COVID-19 is crucial for developing measures for early diagnosis and rational treatment of COVID-19 in this group of patients. Objective: To determine adverse outcome's factors in hospitalized patients with COVID-19/HIV coinfection. Methods: A retrospective cohort study was conducted included 50 patients with coinfection HIV/COVID-19 (32 patients recovered and 18 deaths). The distribution of HIV stages according to the CDC classification was as follows: B2–5 (15.6%) vs. 0 (0.0%), C1-22 (68.8%) vs. 15 (83.3%), stage C2–5 (15.6%) vs. 3 (16.7%), respectively, p>0.05. Results: As a result of the analysis of clinical indicators, the following statistically significant differences were identified: the frequency of respiratory movements in the group with a fatal outcome (Me 23 (N=18), Q1–Q3: 19.2–23) was higher, p=0.008; dyspnea was in almost all patients with a fatal outcome (N=15 (93.8%), OR: 1.6;1.2–2.3, p=0.016); respiratory failure was more pronounced in the group with a fatal outcome, p<0.001: stage 1 occurred only in surviving patients (N=16 (50.0%)), stage 2 (N=9 (50.0%)) and 3 (N=6 (33.3%)) were more common in patients with a fatal outcome (p=0.009 and 0.003, respectively).According to laboratory tests the following features were identified in the deceased group: 1) neutrophils were higher (Me 90.4 (N=18), Q1–Q3: 81.9–95.2), p=0.002; 2) lymphocytes were lower (Me 5.4 (N=18), Q1–Q3: 2.1–9.9), p=0.001; 3) monocytes were lower (Me 4.2 (N=18), Q1–Q3: 0.7–7.8), p=0.017; 4) urea was higher (Me 9.1 (N=18), Q1–Q3: 7.5–13.3), p=0.002; 5) total protein was lower (Me 61.4 (N=18), Q1–Q3: 53.5–67.7), p=0.001; 6) CRP was higher (Me 39.4 (N=18), Q1–Q3: 16.1–94.6), p=0.02.Based on the data obtained factors significant for the development of adverse outcome of COVID-19 in patients with HIV-infection were identified. A prognostic model was built using the binary logistic regression method. The following characteristics had a statistically significant positive effect on the death's probability: respiratory failure and total protein (coefficient of determination - 57.3%, sensitivity – 77.8%, specificity - 84.4%). Discussion: According to the results of laboratory tests there was a reduced antiviral immune response and signs of liver damage in the group with a fatal outcome. The risk of adverse outcome of COVID-19 in patients with HIV-infection was associated with dyspnea, a high frequency of respiratory movements, severe respiratory failure, increased relative numbers of neutrophils and monocytes with a reduced number of lymphocytes, high CRP, urea, and reduced total protein. Conclusion: In cases of the development of respiratory failure symptoms in patients with COVID-19/HIV, immediate hospitalization to the intensive care unit or transfer of a previously hospitalized patient there and the administration of oxygen and broad-spectrum antibiotics for the treatment of bacterial complications are necessary.