新型冠状病毒肺炎合并HIV感染的临床特征及预后的系统文献分析

doi:10.19871/j.cnki.xfcrbzz.2021.02.009

摘要/Abstract

摘要： 目的系统梳理新型冠状病毒肺炎合并HIV感染相关文献,为该类疾病的科学研究和防治管理提供参考。方法系统检索从2019年12月1日到2020年8月11日发表的文献,提取并分析新型冠状病毒肺炎合并HIV感染患者的临床特征及预后不良因素。结果最终筛选出38篇符合纳入标准的文献,共546例新型冠状病毒肺炎合并HIV感染病例,其中有77.1%的患者为男性。该类患者最常见的基础疾病为高血压（40.1%）,其次为糖尿病（22.3%),且合并该两种疾病与患者预后不良相关（P=0.016,P=0.011）。年龄≥50岁的新型冠状病毒肺炎合并HIV感染患者病死率更高（P=0.002）。结论新型冠状病毒肺炎合并HIV感染患者的临床特征及不良预后的危险因素与普通人群相似。目前尚无明确证据表明HIV感染者较普通人群的新型冠状病毒肺炎发病率更高或预后更差,也不认为该人群会因免疫抑制状态或有抗反转录病毒药物使用史而降低罹患新型冠状病毒肺炎的风险或病死率。针对新型冠状病毒肺炎合并HIV感染患者的相关问题仍待进一步探索。

关键词: 人类免疫缺陷病毒, 新型冠状病毒肺炎, 文献分析

Abstract: Objective This systematic review summarizes the literatures on the patients with COVID-19-HIV co-infection, in order to provide references for the scientific research and the prevention or management of patients with COVID-19-HIV co-infection. Methods the literatures published from December 1, 2019 to August 11, 2020 were searched and demographics, the clinical characteristics and adverse prognostic factors of the patients with COVID-19-HIV co-infection were analyzed. Results 38 studies provided specific information on COVID-19 patients living with HIV. A total of 546 COVID-19-HIV co-infected patients were analyzed in this systematic review, of which 77.1% were male. Hypertension (40.1%) and diabetes (22.3%) were the most common comorbidities in patients with COVID-19-HIV co-infection, and the combination of these two diseases were associated with poor prognosis (P=0.016, P=0.011). Additionally, the mortality in patients aged 50 and older was significantly higher than that in those under 50 years old (P=0.002). Conclusions The clinical characteristics and risk factors on poor prognosis in patients with COVID-19-HIV co-infection are similar to that in general population. To date, there is no specific evidence that patients with COVID-19-HIV co-infection have a higher incidence or worse prognosis than general population, and it is not clear that whether the immunosuppressive status or the history of antiretroviral use in patients with COVID-19-HIV co-infection will reduce their mortality risk from COVID-19.The issue of COVID-19-HIV co-infection warrants further investigation.

Key words: Human immunodeficiency virus, Coronavirus disease 2019, Literature analysis

杨钟平, 秦圆圆, 周怡宏, 陈耀凯. 新型冠状病毒肺炎合并HIV感染的临床特征及预后的系统文献分析[J]. 新发传染病电子杂志, 2021, 6(2): 113-118.

Yang Zhongping, Qin Yuanyuan, Zhou Yihong, Chen Yaokai. Clinical features and prognosis of COVID-19 among people living with HIV: a systematic literature analysis[J]. Electronic Journal of Emerging Infectious Diseases, 2021, 6(2): 113-118.

参考文献

[1] WHO. WHO Director-General’s opening remarks at the media briefing on COVID-19—11 March2020. Geneva: World Health Organization [EB/OL]. (Accessed at https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020).
[2] HIV/AIDS JUNPo. Maintaining and prioritizing HIV prevention sevices in the time of COVID-19[EB/OL].(Accessed at https://www.unaids.org/sites/default/files/media_asset/maintaining-prioritizing-hiv-prevention-sevices-covid19_en.pdf).
[3] RIDGWAY JP, FARLEY B, BENOIT JL, et al.A Case Series of Five People Living with HIV Hospitalized with COVID-19 in Chicago, Illinois[J]. AIDS Patient Care STDS, 2020, 34(8):331-335.
[4] SUWANWONGSE K, SHABAREK N.Clinical features and outcome of HIV/SARS-CoV-2 coinfected patients in The Bronx, New York city[J]. J Med Virol, 2020, 92(11):2387-2389.
[5] NAKAMOTO T, KUTSUNA S, YANAGAWA Y, et al.A case of SARS-CoV-2 infection in an untreated HIV patient in Tokyo, Japan[J]. J Med Virol, 2021, 93(1):40-42.
[6] MENGHUA W, XIN Z, JIANWEI L, et al.Case report: one case of coronavirus disease 2019 (COVID-19) in a patient co-infected by HIV with a normal CD4(+) T cell count[J]. AIDS Res Ther, 2020, 17(1): 46.
[7] RUAN L, ZHANG Y, LUO Y, et al.Clinical features and outcomes of four HIV patients with COVID-19 in Wuhan, China[J]. J Med Virol, 2021, 93(1):133-136.
[8] GERVASONI C, MERAVIGLIA P, RIVA A, et al.Clinical features and outcomes of HIV patients with coronavirus disease 2019[J]. Clin Infect Dis, 2020, 71(16):2276-2278.
[9] HO HE, PELUSO MJ, MARGUS C, et al.Clinical outcomes and immunologic characteristics of Covid-19 in people with HIV[J]. J Infect Dis, 2021, 223(3):403-408.
[10] PATEL RH, PELLA PM.COVID-19 in a patient with HIV infection[J]. J Med Virol, 2020, 92(11):2356-2357.
[11] ZHU F, CAO Y, XU S, et al.Co-infection of SARS-CoV-2 and HIV in a patient in Wuhan city, China[J]. J Med Virol, 2020, 92(6): 529-530.
[12] CHEN J, CHENG X, WANG R, et al.Computed tomography imaging of an HIV-infected patient with coronavirus disease 2019[J]. J Med Virol, 2020, 92(10):1774-1776.
[13] MOLINA IE, SAN-JOSÉ-MUÑIZ I, Ganchegui-Aguirre M, et al. Coronavirus disease 2019 in patients with HIV in the province of Araba, Basque Country, Spain[J]. AIDS, 2020, 34(11): 1696-1697.
[14] TOOMBS JM, VAN DEN ABBEELE K, DEMOCRATIS J, et al. COVID-19 in three people living with HIV in the United Kingdom[J]. J Med Virol, 2021, 93(1):107-109.
[15] KUMAR RN, TANNA SD, SHETTY AA, et al.COVID-19 in an HIV-positive kidney transplant recipient[J]. Transpl Infect Dis, 2020, 22(5):e13338.
[16] BLANCO JL, AMBROSIONI J, GARCIA F, et al.COVID-19 in patients with HIV: clinical case series[J]. Lancet Hiv, 2020, 7(5):e314-e316.
[17] CALZA L, BON I, TADOLINI M, et al.COVID-19 in patients with HIV-1 infection: a single-centre experience in northern Italy[J]. Infection, 2021, 49(2):333-337.
[18] HÄRTER G, SPINNER CD, ROIDER J, et al. COVID-19 in people living with human immunodeficiency virus: a case series of 33 patients[J]. Infection, 2020, 48(5):681-686.
[19] VIZCARRA P, PÉREZ-ELÍAS MJ, QUEREDA C, et al. Description of COVID-19 in HIV-infected individuals: a single-centre, prospective cohort[J]. Lancet HIV, 2020, 7(8): e554-e564.
[20] BENKOVIC S, KIM M, SIN E.Four cases: Human immunode-ficiency virus and novel coronavirus 2019 Co-infection in patients from Long Island, New York[J]. J Med Virol, 2020, 92(11):2338-2340.
[21] BALUKU JB, MWEBAZA S, INGABIRE G, et al.HIV and SARS-CoV-2 coinfection: A case report from Uganda[J]. J Med Virol, 2020, 92(11):2351-2353.
[22] ALTUNTAS AO, KUMBASAR KH, KART YK.HIV/SARS-CoV-2 coinfected patients in Istanbul, Turkey[J]. J Med Virol, 2020, 92(11):2288-2290.
[23] CHILDS K, POST FA, NORCROSS C, et al.Hospitalized patients with COVID-19 and HIV: a case series[J]. Clin Infect Dis, 2020, 71(8):2021-2022.
[24] KARMEN TS, CARLUCCI PM, ZERVOU FN, et al.Outcomes among HIV-positive patients hospitalized with COVID-19[J]. J Acquir Immune Defic Syndr, 2020, 85(1):6-10.
[25] WU Q, CHEN T, ZHANG H.Recovery from the coronavirus disease-2019 (COVID-19) in two patients with coexisted (HIV) infection[J]. J Med Virol, 2020, 92(11):2325-2327.
[26] BYRD KM, BECKWITH CG, GARLAND JM, et al.SARS-CoV-2 and HIV coinfection: clinical experience from Rhode Island, United States[J]. J Int AIDS Soc, 2020, 23(7): e25573.
[27] IORDANOU S, KOUKIOS D, MATSENTIDOU CT, et al.Severe SARS-CoV-2 pneumonia in a 58-year-old patient with HIV: a clinical case report from the Republic of Cyprus[J]. J Med Virol, 2020, 92(11):2361-2365.
[28] RIVA A, CONTI F, BERNACCHIA D, et al.Darunavir does not prevent SARS-CoV-2 infection in HIV patients[J]. Pharmacol Res, 2020, 157:104826.
[29] ZHAO J, LIAO X, WANG H, et al.Early virus clearance and delayed antibody response in a case of COVID-19 with a history of co-infection with HIV-1 and HCV[J]. Clin Infect Dis, 2020, 71(16):2233-2235
[30] SU J, SHEN X, NI Q, et al.Infection of severe acute respiratory syndrome coronavirus 2 in a patient with AIDS[J]. AIDS, 2020, 34(10): 1575-1576.
[31] SIGEL K, SWARTZ T, GOLDEN E, et al.Covid-19 and People with HIV Infection: Outcomes for Hospitalized Patients in New York City[J]. Clin Infect Dis, 2020, 71(11):2933-2938.
[32] LI W, MA Q, WANG X, et al.The characteristics of two patients coinfected with SARS‐CoV‐2 and HIV in Wuhan, China[J]. J Med Virol, 2021, 93(1):85-88.
[33] OKOH AK, BISHBURG E, GRINBERG S, et al.COVID-19 pneumonia in patients with HIV - A Case Series[J]. J Acquir Immune Defic Syndr, 2020, 85(1):e4-e5.
[34] WANG M, LUO L, BU H, et al.One case of coronavirus disease 2019 (COVID-19) in a patient co-infected by HIV with a low CD4(+) T-cell count[J]. Int J Infect Dis, 2020, 96: 148-150.
[35] SHALEV N, SCHERER M, LASOTA ED, et al.Clinical characteristics and outcomes in people living with HIV hospitalized for COVID-19[J]. Clin Infect Dis, 2020, 71(16):2294-2297.
[36] SUWANWONGSE K, SHABAREK N.Variation in mortality of HIV/SARS-CoV-2 co-infected patients in the Bronx, New York City[J]. J Med Virol, 2021, 93(2):603-605.
[37] SASSET L, DI MECO E, Cavinato S, et al.Coinfection of severe acute respiratory syndrome coronavirus 2 and HIV in a teaching hospital: still much to learn[J]. AIDS, 2020, 34(11): 1694-1696.
[38] JOUMAA H, REGARD L, CARLIER N, et al.A severe COVID-19 despite ongoing treatment with Lopinavir-Ritonavir[J]. Respir Med Res, 2020, 78: 100780.
[39] GUO W, MING F, FENG Y, et al.Patterns of HIV and SARS-CoV-2 co-infection in Wuhan, China[J]. J Int AIDS Soc, 2020, 23(7): e25568.
[40] PRZYDZIAL P, TCHOMOBE G, AMIN K, et al.COVID-19 crossing paths with AIDS in the homeless[J]. J Med Virol, 2021, 93(1):155-157.
[41] CHEN N, ZHOU M, DONG X, et al.Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study[J]. Lancet, 2020, 395(10223): 507-513.
[42] RICHARDSON S, HIRSCH JS, NARASIMHAN M, et al.Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area[J]. JAMA, 2020, 323(20):2052-2059.
[43] TAHVILDARI A, ARBABI M, FARSI Y, et al.Clinical Features, Diagnosis, and Treatment of COVID-19 in Hospitalized Patients: A Systematic Review of Case Reports and Case Series[J]. Front Med (Lausanne), 2020, 7: 231.
[44] 林绿, 刘夏, 吴念宁, 等. 血清心肌损伤指标变化与新型冠状病毒肺炎重症风险的相关性研究[J/CD]. 新发传染病电子杂志, 2020, 5(3):159-164.
[45] WANG D, HU B, HU C, et al.Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China[J]. JAMA, 2020, 323(11):1061-1069.
[46] LIU K, CHEN Y, LIN R, et al.Clinical features of COVID-19 in elderly patients: A comparison with young and middle-aged patients[J]. J Infect, 2020, 80(6): e14-e18.
[47] WHO. Q&A: HIV, antiretrovirals and COVID-19[EB/OL].(Accessed at https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/q-a-on-covid-19-hiv-and-antiretrovirals).
[48] HILEMAN CO, FUNDERBURG NT. Inflammation, Immune Activation,Antiretroviral Therapy in HIV[J]. Curr HIV/AIDS Rep, 2017, 14(3): 93-100.
[49] MARIMUTHU J, KUMAR BS, ARAVIND GANDHI P.HIV and SARS CoV-2 co-infection: A retrospective, record based, case series from South India[J]. J Med Virol, 2021, 93(1):163-165.
[50] ZHOU YH, LI H, QIN YY, et al.Predictive factors of progression to severe COVID-19[J]. Open Medicine, 2020, 159(1): 805-814.
[51] HU D, LI L, SHI W, et al.Less expression of CD4(+) and CD8(+) T cells might reflect the severity of infection and predict worse prognosis in patients with COVID-19: Evidence from a pooled analysis[J]. Clin Chim Acta, 2020, 510: 1-4.
[52] 中华医学会感染病学分会艾滋病丙型肝炎学组, 中国疾病预防控制中心. 中国艾滋病诊疗指南(2018版)[J/CD]. 新发传染病电子杂志, 2019, 4(2):65-84.
[53] CHOY KT, WONG AY, KAEWPREEDEE P, et al.Remdesivir, lopinavir, emetine, and homoharringtonine inhibit SARS-CoV-2 replication in vitro[J]. Antiviral Res, 2020, 178: 104786.
[54] ELFIKY AA. Ribavirin, Remdesivir, Sofosbuvir, Galidesivir,Tenofovir against SARS-CoV-2 RNA dependent RNA polymerase (RdRp): A molecular docking study[J]. Life Sci, 2020, 253: 117592.
[55] MIRZAEI H, MCFARLAND W, KARAMOUZIAN M, et al.COVID-19 Among People Living with HIV: A Systematic Review[J]. AIDS Behav, 2021, 25(1):85-92.
[56] CAO B, WANG Y, WEN D, et al.A Trial of Lopinavir-Ritonavir in Adults Hospitalized with Severe Covid-19[J]. N Engl J Med, 2020, 382(19): 1787-1799.
[57] BLANCO JL, AMBROSIONI J, GARCIA F, et al.COVID-19 in patients with HIV: clinical case series[J]. Lancet HIV, 2020, 7(5): e314-e316.