Clinical progression of COVID-19 coinfection in people living with the human immunodeficiency virus: scoping review

Schaurich, Diego; Munhoz, Oclaris Lopes; Ramos Junior, Angelo; Dalmolin, Angelica; Oliveira, Gabriela; Cremonese, Luiza

doi:10.1590/0034-7167-2020-1380

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Revista Brasileira de Enfermagem

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REVIEW • Rev. Bras. Enferm. 75 (02) • 2022 • https://doi.org/10.1590/0034-7167-2020-1380 copy

Clinical progression of COVID-19 coinfection in people living with the human immunodeficiency virus: scoping review

Curso clínico de la coinfección COVID-19 en personas que viven con el virus de la inmunodeficiencia humana: scoping review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to map the production of scientific knowledge on the clinical progression of COVID-19 coinfection in people living with the human immunodeficiency virus (HIV).

Methods:

scoping review, with search strategies in MEDLINE, Scopus, Embase, Web of Science, and LILACS. Dual independent data extraction and analysis of the material with similarity compilation and narrative synthesis.

Results:

sample consisted of 35 articles. Fever, cough, and dyspnea were the most prevalent signs/symptoms. Recurrent complications involved desaturation/worsening of oxygen desaturation and pneumonia. No standard pharmacological treatment was identified, and the main interventions involved the provision of supplemental oxygen and mechanical ventilation. The studies recommended preventive, care, and pharmacological practices.

Conclusions:

the clinical manifestations, complications, and treatments/assistance care for people coinfected with SARS CoV-2/HIV are similar to those of the general population. Coinfection, overall, does not infer a worse prognosis.

Descriptors:
Coronavirus Infections; Pandemics; HIV; Acquired Immunodeficiency Syndrome; Communicable Diseases

Variables	n	%
Sex
Male	91	85.8
Female	15	14.2
Age group
22 to 29 years old	9	8.5
30 to 39 years old	28	26.4
40 to 49 years old	19	17.9
50 to 59 years old	29	27.4
60 to 69 years old	17	16.0
70 to 79 years old	3	2.9
≥ 80 years old	1	0.9
HIV diagnosis period
1985 to 1989	3	2.9
1990 to 1999	7	6.6
2000 to 2009	23	21.7
2010 to 2019	36	33.4
2020	4	3.8
Not reported	33	31.6
Comorbidities^* * 104 comorbidities were identified. Some patients had more than one comorbidity;
Hypertension	31	29.9
Diabetes mellitus	14	13.5
Chronic obstructive bronchopulmonary disorder	9	8.6
Hyperlipidemia	6	5.8
Viral hepatitis	5	4.8
Obesity	5	4.8
Others	34	32.7
Length of hospitalization^† † three patients remained at home during recovery. (n = 60)
1 to 5 days	11	18.3
6 to 10 days	21	35.0
11 to 15 days	16	26.6
16 to 20 days	2	3.3
21 to 25 days	6	10.0
≥ 26 days	4	6.8

CLINICAL MANIFESTATIONS
Signs and symptoms: - Most prevalent: fever (n = 82; 77.4%), cough (n = 76; 71.7%), dyspnea (n = 32; 30.2%), fatigue (n = 17; 16.0%), headache (n = 15; 14.2%), myalgia/arthralgia (n = 15; 14.2%). - Less prevalent: sore throat (n = 10; 9.4%), diarrhea (n = 9; 8.5%), anosmia (n = 7; 6.6%), chest pain (n = 4; 3.8%), vomiting (n = 3; 2.8%), dizziness (n = 2; 1.9%), tachycardia (n = 2; 1.9%), chills (n = 2; 1.9 %), weakness (n = 2; 1.9%), abdominal pain (n = 2; 1.9%). - Rare: ageusia (n = 1; 0.9%), dehydration (n = 1; 0.9%), hypoxia (n = 1; 0.9%), mental confusion (n = 1; 0.9%). Asymptomatic: 5 patients (4.7%).	Laboratory and imaging tests: - RT-PCR^* * RT-PCR - Reverse-Transcriptase Polymerase Chain Reaction; positive for SARS-CoV-2. - Computed tomography and chest radiography with a ground/opaque glass aspect. - Lymphopenia. - High C-reactive protein. - Thrombocytopenia. - Elevated Alanine aminotransferase. - Thrombocytopenia. - High lactate dehydrogenase. - Elevated troponin.
TREATMENTS
There was no pattern of treatment. However, they were based on maintaining routine ART†; antibiotics; analgesics; anti-inflammatory drugs; corticosteroids; antimalarial/antirheumatic; antifungals; cough suppressants; and vitamin supplements.
COMPLICATIONS
- Most prevalent: desaturation/worsening of O2 desaturation (n = 11; 10.4%); fungal/bacterial pneumonias (n = 8; 7.5%). - Less prevalent: cardiorespiratory arrest (n = 2; 1.9%); leukopenia (n = 2; 1.9%). - Rare (n = 1; 0.9%): non-sustained ventricular tachycardia; cardiomegaly without infiltrate; wedge-shaped splenic infarction; maculopapular eruption in lower limbs; acute liver injury; encephalopathy; tonic-chronic seizures; acute respiratory distress syndrome; acute kidney injury; diarrhea; tachypnea; hemoptysis; cranial nerve palsy with ptosis; patient self-inflicted lung injury.
INTERVENTIONS
- Supplemental oxygen via nasal cannula and reservoir mask. - Invasive and non-invasive mechanical ventilation. - Sedoanalgesia. - Extracorporeal membrane oxygenation. - Tracheostomy. - Vascular Doppler exam. - Thoracic (computed tomography and radiography) and cardiac (electrocardiogram) imaging exams.
RECOMMENDATIONS
1) Preventive - Uncomplicated cases of SARS-CoV-2/HIV coinfection can be treated through self-isolation at home. - Home isolation for at least 14 days. - The use of telemedicine to identify the initial symptoms of COVID-19, for psychosocial support and for coinfection control as a fundamental health care strategy for this population. - People with advanced or poorly controlled HIV (CD4 < 500 mm³) and/or with risk factors (over 50 years and presence of comorbidities: diabetes, hypertension, chronic smoking) co-infected with SARS-CoV-2 may have a higher risk of death. 2) Assistance - COVID-19 pneumonia in patients with untreated HIV requires careful monitoring, with ART^† † ART - antiretroviral therapy; , of the immune reconstitution inflammatory syndrome. - Due to their similar clinical and radiological characteristics, the diagnoses of Pneumocystis jirovecii and COVID-19 pneumonia need to be clarified. - Individuals co-infected with SARS-CoV-2/HIV can be treated with the same standard care applied to the general population. - When agitation prevents the safe transport of patients for imaging/testing exams, intubation and sedation should be considered as an option to achieve safer conditions for imaging and diagnostic imaging. - It is highly recommended to monitor blood drug levels whenever possible in patients co-infected with SARS-CoV-2/HIV. - Due to the potential for aerosol generation, obtaining an induced sputum sample for Pneumocystis carinii pneumonia testing is currently not recommended. 3) Pharmacological - Assess the potential of pharmacological interactions between ART^† † ART - antiretroviral therapy; and treatment for COVID-19 in co-infected people. - Be aware that co-administration with antiretroviral drugs that inhibit or induce metabolism may increase the concentration of chloroquine or decrease the concentration of hydroxychloroquine. - Lopinavir/ritonavir may elevate plasma concentrations of chloroquine/hydroxychloroquine and remdesivir, and adverse effects or toxicity are likely to increase. - The effect of remdesivir may be influenced by strong antiretroviral inhibitors/inducers of metabolism, therefore co-administration is not recommended. - Early initiation of antimicrobial treatment may translate into a lower risk of opportunistic infections. - Tenofovir, one of the most widely prescribed anti-HIV drugs for pre-exposure HIV treatment and prophylaxis, blocks the RNA-dependent^‡ ‡ RNA - Ribonucleic acid. RNA^‡ ‡ RNA - Ribonucleic acid. polymerase critical of SARS-CoV-2.

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[1] Corresponding author: Diego Schaurich E-mail: eu_diegosch@hotmail.com

Authors	Article title	Periodical title	Country / Month in 2020	Design/Type of production
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