Characterization of people living with HIV in a Montreal-based tertiary care center with COVID-19 during the first wave of the pandemic

ABSTRACT

People living with HIV (PLWH) often have worse health outcomes compared to HIV-uninfected individuals. We characterized PLWH followed at a tertiary care clinic in Montreal who acquired COVID-19 and described their outcomes during the first wave of the pandemic. A retrospective chart review was performed for PLWH followed at the Chronic Viral Illness Service with a positive COVID-19 nasopharyngeal PCR or symptoms suggestive of COVID-19 between 1 March and 15 June 2020. Data on demographics, socioeconomic status, co-morbidities and severity of COVID-19 and outcomes were extracted. Of 1702 individuals, 32 (1.9%) had a positive COVID-19 test (n = 24) or symptoms suspicious for COVID-19 (n = 3). Median age was 52 years [IQR 40, 62]. Nearly all (97%) earned $34,999 Canadian dollars or less. Eleven (34%) individuals worked in long-term care (LTC) homes while 5 (6%) lived in LTC homes. Median CD4 count was 566 cells/mm³ [347, 726] and six had detectable plasma HIV viral loads. Median duration of HIV was 17 years [7, 22] and 30 individuals had been prescribed antiretroviral therapy. Five persons were asymptomatic. Of symptomatic persons, 21 (12%), 1 (4%) and 3 (12%) individuals had mild, moderate and severe disease, respectively. Three individuals died with COVID-19. In one case, the cause of death was due to COVID-19, whereas in the other two cases, the individuals died with positive COVID-19 test results but the immediate cause of death is unclear. PLWH who tested positive for COVID-19 had low socioeconomic status and had employment or living conditions that put them at high risk. PLWH may be disproportionately impacted by the social determinants of health which predispose them to COVID-19.

KEYWORDS:

• HIV
• COVID-19
• vulnerable populations
• long-term care facilities
• asylum seekers
• socioeconomic status

Acknowledgements

We thank all the health care workers who contributed to the care of persons during the COVID-19 pandemic.

Disclosure statement

DF, LR, MB, NO, EB, MAJ, AA, CF, AdP, AG, CT, NZ, JS, KD, MJB, HT, CD, JLL, JF, MK, JPR: No competing interests reported.

BL has received consultancy fees and/or honoraria from Gilead, Merck, and ViiV, and research funds from Gilead, Merck, and ViiV, support to attend educational conferences from Viiv Healthcare and Gilead. All research funds were administered by the RI-MUHC.

JC has received research funding from Gilead, Merck and ViiV, financial support to attend to conferences from Gilead and ViiV, and personal fees for advisory services from Gilead, Merck and ViiV.

MPC reports grants from the Canadian Institute of Health Research and McGill Interdisciplinary Initiative in Infection and Immunity during the conduct of the study; he is also on the scientific advisory board of GEn1E Lifesciences, but this position is unrelated to the submitted work.

NK has received research funding from Gilead Sciences, advisory fees from Gilead Sciences, ViiV Healthcare, Merck and Abbvie, and speaker fees from Gilead Sciences.

CTC has received research funds from Gilead, Merck and Astra Zeneca and support to attend educational conferences from Viiv Healthcare and Gilead. She has received funds to develop educational material for trainees from Gilead, Merck and Viiv Healthcare, speaker fees from Gilead and advisory fees from Viiv.

Data availability

May be made available depending upon the request.

Additional information

Funding

No funding was received for the preparation of this manuscript. CTC and NK are supported by a Fonds de recherche du Québec Santé (FRQ-S) chercheur boursier clinicien Junior 1 salary awards while AdP is supported by an FRQ-S Junior 2 salary award. BL is also supported by a career award LE 250 from the Quebec’s Ministry of Health for researchers in Family Medicine. BL holds a Canadian Institutes for Health Research Strategy for Patient Oriented Research (SPOR) Mentorship Chair in Innovative Clinical Trials and MK holds a CIHR Canada Research Chair in Hepatitis C in Vulnerable Populations. JPR holds the McGill University Louis Lowenstein Chair in Hematology & Oncology. The funding institutions played no role in the design, collection, analysis, and interpretation of data.