CEEISCAT researchers coordinate a project identifying the risk factors for severe covid-19 for people living with HIV
The study published in The Lancet HIV journal and coordinated by researchers from the Center for Epidemiological Studies on Sexually Transmitted Infections and AIDS in Catalonia (CEEISCAT), a group affiliated to the IGTP and researchers from the Hospital Clínic de Barcelona has determined the factors associated with higher risk of severe COVID-19 among people living with HIV. Having a detectable viral load of HIV, being born outside of Spain, being over 65 years of age and suffering from other chronic diseases are determining factors of severe disease, such as hospitalization, admission to the ICU or the death.
The researchers carried out the study within the framework of the PISCIS cohort of people living with HIV in Catalonia and the Balearic Islands with the participation of researchers from the 16 Catalan hospitals in the cohort to describe the determinant factors of severe diseases due to COVID-19 among people living with HIV in Catalonia. To do this, they linked the data of the cohort participants in follow-up with data from the Program of data analytics for research and innovation in health (PADRIS) of the Agency for Health Quality and Evaluation of Catalonia (AQuAS). The researchers identified 749 people (5.7% of the cohort) diagnosed with SARS-CoV-2 between March 1 and December 15, 2020, of which 14% were admitted to the hospital as a result of COVID-19. Seven of these people were admitted to an intensive care unit and a total of thirteen patients died.
The study analyzed the chronic comorbidities associated with severe COVID-19 disease by identifying hypertension, cardiovascular disease, chronic kidney disease or cancer as pathologies that significantly increase the risk of a serious outcome. As explained by the researchers from the CEEISCAT, Daniel Nomah and Juliana Reyes-Urueña, first authors of the article, "people with a chronic pathology were almost six times more likely to have a severe outcome compared to people without comorbidities. Each additional comorbidity was associated with a substantial increase in risk, reaching a 22-fold increase in the risk of having a severe COVID-19 outcome among people with four or more comorbidities".
On the other hand, the principal investigators of the PISCIS cohort, Jordi Casabona, the director of CEEISCAT, and Josep Maria Miró, Senior Consultant at the Hospital Clínic de Barcelona, highlight that "people aged 65 years or older living with HIV were three times and a half more likely to have severe COVID-19 results compared to younger people. Similarly, being born outside of Spain is also a key factor in the risk of severe forms of COVID-19 among people living with HIV in Catalonia ".
The researchers also examined the relationship between CD4 cell count, viral load, and severe COVID-19 outcomes. They have found that, while the CD4 count does not affect the risk of severe COVID-19 in people with suppressed viral load, in people with detectable HIV viral load there is an association with an increased risk of a severe COVID-19 outcome.
The study, which is funded by the "la Caixa" Foundation, which for years has supported epidemiological research on HIV in Catalonia through the PISCIS cohort, concludes that the identified risk factors should assist to prioritize people with HIV in terms of testing strategies, clinical management and vaccination programs against SARS-CoV-2, especially people with unsuppressed HIV viral load and low CD4 cell count, as well as those with a high number of comorbidities. As Daniel Nomah and Juliana Reyes-Urueña conclude, "people living with HIV with a CD4 cell count <200 cells/ul must be prioritized to receive the third dose of the vaccine and some of these patients are already receiving it".
A long-term project
The PISCIS cohort of people living with HIV in Catalonia and the Balearic Islands is coordinated by the CEEISCAT and has the participation of 16 hospitals in Catalonia and 2 in Mallorca. Since 1998, the cohort has collected information on people living with HIV and who are receiving care in these hospitals in order to carry out studies like this one that improves the care of people living with HIV. In recent years, they have also carried out studies on the quality of life of the people who are part of the cohort and are currently working on the recovery of patients who have been lost to clinical follow-up in their respective hospitals. The hospitals that are part of the cohort are: Hospital Clínic de Barcelona, Hospital Universitari Germans Trias i Pujol, Hospital Universitari de Bellvitge, Hospital Universitari Vall d'Hebron, Hospital de la Santa Creu i Sant Pau, Hospital del Mar - Parc de Salut Mar, Hospital Universitari Son Espases, Consorci Corporació Sanitària Parc Taulí de Sabadell, Hospital Son Llàtzer, Hospital Universitari de Santa Maria de Lleida, Hospital Universitari Joan XXIII de Tarragona, Hospital de Mataró, Hospital General de l'Hospitalet, Hospital de Palamós, Hospital Universitari de Vic, Verge de la Cinta Hospital in Tortosa, Mutua Terrassa University Hospital and Granollers General Hospital.
Daniel K Nomah, Juliana Reyes-Urueña, Yesika Díaz, Sergio Moreno, Jordi Aceiton, Andreu Bruguera et al.
Published:October 13, 2021DOI:https://doi.org/10.1016/S2352-3018(21)00240-X