Preprints with The Lancet is part of SSRN´s First Look, a place where journals identify content of interest prior to publication. Authors have opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early stage research papers that have not been peer-reviewed. The findings should not be used for clinical or public health decision making and should not be presented to a lay audience without highlighting that they are preliminary and have not been peer-reviewed. For more information on this collaboration, see the comments published in The Lancet about the trial period, and our decision to make this a permanent offering, or visit The Lancet´s FAQ page, and for any feedback please contact preprints@lancet.com.
The Presence of Both Typical or Atypical Radiological Changes Predicts Poor COVID-19 Outcomes in HIV-Positive Patients From a Multinational Observational Study: Data From Euroguidelines in Central and Eastern Europe Network Group
20 Pages Posted: 31 Jan 2022
More...Abstract
Background: HIV-positive patients may present lung infections differently, which may hinder differential diagnoses and the choice of treatment in the course of COVID-19, especially in countries with limited access to high standard healthcare. Here we aim to investigate the association between radiological changes and poor COVID-19 outcomes among HIV-positive patients from Central and Eastern Europe.
Methods: Since November 2020, the Euroguidelines in Central and Eastern Europe Network Group started collecting observational data on HIV and COVID-19 co-infections. In total, 16 countries from Central and Eastern European submitted data (eCRF) on 557 HIV-positive patients. The current analyses included patients who had a radiological examination performed. Logistic regression models were used to identify the factors associated with death, ICU admission, and partial recovery (poor COVID-19 outcomes). Factors that were significant in the univariate models (p<0.1) were included in multivariate model.
Results: Radiological data were available for 224 (40.2%) patients, 108 (48.2%) had computed tomography, and 116 (51.8%) had a chest X-ray. Of these, 211 (94.2%) were diagnosed using RT-PCR tests, 212 (94.6%) were symptomatic, 123 (55.6%) were hospitalized, 37 (16.6%) required oxygen therapy, and 28 (13.1%) either died, were admitted to ICU, or only partially recovered. From the radiologist’s description, 138 (61.6%) patients had typical radiological changes, 18 (8.0%) atypical changes, and 68 (30.4%) no changes. In the univariate models, CD4 count (OR=0.86 [95% CI: 0.76–0.98]), having a comorbidity (2.33 [1.43–3.80]), HCV and/or HBV co-infection (3.17 [1.32–7.60]), being currently employed (0.31 [0.13–0.70]), being on antiretroviral therapy (0.22 [0.08–0.63]), and having typical (3.90 [1.12–13.65]) or atypical (10.8 [2.23–52.5]) radiological changes were all significantly associated with poor COVID-19 outcomes. In the multivariate model, being on antiretroviral therapy (OR=0.20 [95% CI:0.05–0.80]) decreased the odds of poor COVID-19 outcomes; while having a comorbidity (2.12 [1.20–3.72]), or either typical (4.23 [1.05–17.0]) or atypical (6.39 [1.03–39.7]) radiological changes (vs no changes) increased the odds of poor COVID-19 outcomes.
Conclusions: Among HIV patients diagnosed with symptomatic SARS-CoV-2 infection, the presence of either typical or atypical radiological COVID-19 changes independently predicted poorer outcomes.
Funding Information: No funding was received.
Declaration of Interests: The authors declare no conflict of interest.
Ethics Approval Statement: The design of this work conforms to the standards currently applied in the Medical University of Warsaw’s Bioethics Committee. Approval number: AKBE/155/2020.
Keywords: HIV, COVID-19, ECEE, pneumonia, ARDS, SARS-CoV-2
Suggested Citation: Suggested Citation