Immunologic characteristics of acute COVID-19 in people with HIV

Background: Data on the immunologic impact of SARS-CoV-2 coinfection in people living with HIV (PLWH) are limited Methods: We conducted a retrospective study of clinical and immunologic outcomes of COVID-19 in 93 PLWH presenting to 5 New York City emergency departments who tested positive for SARSCoV-2 by nucleic acid amplification Results: Median previous CD4+ T lymphocyte count was 554 cells/uL, and 57/68 individuals (83 8%) had recent plasma HIV-1 RNA measurements below 50 copies/mL Sixty-two of 89 (69 6%) were on antiretroviral therapy (ART) that included tenofovir At presentation, PLWH with COVID-19 demonstrated significant lymphopenia and decreased CD4+ T cell counts Levels of inflammatory markers, including C-reactive protein (CRP), fibrinogen, and D-dimer were commonly elevated Serum cytokine profiles during acute COVID-19 were characterized by elevated interleukin (IL)-6, IL-8, and TNF-alpha, but not IL-1b Of 72 PLWH hospitalized with COVID-19, 16 (22 2%) died, 48 (66 7%) recovered, and 8 (11 1%) remained hospitalized at the time of analysis Those who died had significantly lower nadir absolute lymphocyte counts during COVID-19 compared with those who recovered Peak inflammatory markers including CRP, fibrinogen, and IL-6 were significantly higher in those who died;there were non-significant trends toward IL-8 and TNF-alpha elevations No difference was observed in age, sex, BMI, duration of HIV infection, nadir, preceding, or presenting CD4+ T cell count, or viral suppression preceding or during the COVID-19 presentation A greater proportion in the recovered group was on a regimen containing tenofovir, but the difference was not statistically significant Conclusions: PLWH who died of COVID-19 had significantly higher levels of soluble markers of immune activation and inflammation and more severe lymphopenia than those who survived Our findings indicate that a subset of PLWH are capable of mounting profound inflammatory responses that have been noted to correlate with poor outcomes in people without HIV Taken together, these findings raise important concerns that PLWH remain at risk for severe manifestations of COVID-19 despite ART, and that prominent immune dysregulation in a subset of PLWH during infection is associated with worse outcomes Further studies are warranted to determine whether inflammatory pathways are exacerbated or potentiated in some PLWH compared with the general population