Due to the high risk, HIV-infected individuals should prioritize COVID-19 vaccination. WHO recommends

The World Health Organization said last week that people living with HIV should prioritize COVID-19 vaccination, showing that people with HIV are at increased risk of being hospitalized at the 11th International AIDS Society HIV Science Conference. Received the presentation of his research. With severe COVID-19, he dies of COVID-19.

A World Health Organization study of more than 15,000 cases of COVID-19 in people living with HIV found that:

• People living with HIV were 13% more likely to be hospitalized for severe or severe COVID-19 after managing age, gender, and comorbidities.
• They were more likely to die after being hospitalized for COVID-19. People living with HIV had a 30% increased risk of death, regardless of age, gender, severity at onset, and comorbidities.
• Among people living with HIV, diabetes, hypertension, men or over 75 years of age were each associated with an increased risk of death.

The increased risk of severe COVID-19 is modest, but it is especially important in countries like South Africa, where the number of people living with HIV is high, Dr. Sylvia Bertagnorio of WHO told AIDS Maps. “This is important in an expanded healthcare system where HIV-infected people may have more serious illnesses and require more medical resources.”

WHO has investigated the COVID-19 risk of people living with HIV. Previous studies have produced conflicting results..

WHO Global Clinical Platform Research

The World Health Organization’s COVID-19 global clinical platform has collected data on 268,412 individual patients admitted to COVID-19 since the inception of the pandemic. Anonymized patient data is submitted to the platform by national registries and sentry medical facilities in 37 countries.

To investigate the impact of HIV on COVID-19 results, Dr. Bertagnolio and WHO colleagues identified results data for 15,522 people living with HIV from platforms in 24 countries submitted by April 29, 2021. Did. The majority of these cases (94.6%) were reported from South Africa.

The researchers examined two results of people living with HIV compared to the rest of the population: inpatient mortality and the severity of illness at admission.

A case was defined as severe if one or more of the following criteria were met on admission: Oxygen saturation is 90% or less. Adults and children over the age of 5 breathe in one minute when the respiratory rate exceeds 30. Oxygen is supplied using an artificial lung (ECMO). Treatment with inotropic or hypertensive agents (used in critical care settings to treat shock or heart problems); oxygen therapy or ventilation; treatment in the intensive care unit. Cases that did not meet these criteria were classified as mild or moderate.

The majority of people living with HIV hospitalized with COVID-19 were women (63%) and were relatively young (49% 18-45 years old, 41% 45-65 years old). One-third had hypertension, 22% diabetes, 16% obesity, 13% tuberculosis, 12% chronic kidney disease, and 12% chronic liver disease.

Over one-third (5563) of HIV-infected persons admitted to the hospital were infected with severe or severe COVID-19. Of these, 35% died. Of those with mild or moderate illness on admission, 17% died.

Looking at all COVID-19 cases reported on the global platform, WHO states that HIV patients are at increased risk of serious or serious illness at admission after adjusting for age, gender, and presence of underlying illness. Was found (adjusted odds ratio 1.06, 95% confidence interval 1.02-1.11). Excluding cases from South Africa increased the risk, leaving 425 cases for which severity data were available (adjusted odds ratio 2.27, 95% CI 1.73-2.97).

Older age, diabetes, and high blood pressure each increased the risk of hospitalization for serious illnesses in HIV-infected persons.

HIV-infected persons are also at increased risk of dying after being hospitalized with COVID-19 (adjusted hazard ratio 1.29, 95% CI 1.23-1.35) after adjusting for age, gender, disease severity, and underlying disease. I did.

As with severe illness, after admission to COVID-19 in HIV patients, old age, diabetes, and hypertension each increased the risk of death in the hospital. Age and diabetes had a more significant effect on mortality risk than male gender and hypertension (aHR 1.82, [95% CI 1.62-2.04] And 1.50 (95% CI 1.39-1.62, respectively).

Analysis of mortality risk in the WHO region showed that HIV remained an independent risk factor for post-hospital mortality in the WHO Africa region (aHR 1.29, 95% CI 1.23-1.34), while in the WHO Europe region (aHR 0.59, aHR 0.59,). That was not the case with 95% CI). 0.29-1.2 or WHO region of the Americas (aHR 0.92, 95% CI 0.37-2.31). Due to the smaller number of cases compared to the African region, the confidence intervals in these regions are wide.

The data submitted to the platform about people living with HIV did not include information about CD4 counts and viral load, so it was not possible to determine whether these factors affected the outcome of people living with HIV. Information on antiretroviral treatment was available only in 40% of the cases submitted.

Impact on vaccination policy

The World Health Organization last week recommended that people living with HIV should prioritize vaccination. A quick survey of 100 countries by WHO found that 40 countries already prioritized HIV-infected people, including many in India, Indonesia, Latin America and North America. However, prioritization is only half of the equation. Countries also need access to vaccine supplies.

“There is a decisive need for vaccination fairness. In low- and middle-income countries, vaccination rates are only 3-4%, so everyone should be given the first dose,” WHO said. Dr. Megdhati, director of the Global HIV, Hepatitis, and STI Program, said at a press conference.

Dr. Adeeba Kamarulzaman, President of the International AIDS Society, commented: [on vaccination for people with HIV] Just as the 2000 Durban Conference revitalized the HIV community and ensured that antiretroviral therapy reached people in low-income countries.It took me five years to get there […] So don’t repeat that mistake. “

Dr. Dougherty also emphasized the importance of strengthening testing activities. “There are at least 10 million people who are unaware of their HIV status. We need to make sure that people are being tested.”