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

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

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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 copiar

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

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivos:

mapear producción del conocimiento científico acerca del curso clínico de la coinfección por COVID-19 en personas que viven con el virus de la inmunodeficiencia humana (VIH).

Métodos:

revisión de objetivos, con estrategias de búsqueda en la MEDLINE, Scopus, Embase, Web of Science y LILACS. Extracción de los datos y análisis del material de manera duplo-independiente, con compilación por similaridad y síntesis de manera narrativa.

Resultados:

muestra constituida de 35 artículos. Fiebre, tos y disnea fueron signos/síntomas más predominantes. Las complicaciones recurrentes envolvieron desaturación/peora de la desaturación de oxígeno y neumonías. No ha sido identificado un tratamiento farmacológico estándar, y las principales intervenciones envolvieron oferta de oxígeno suplementario y ventilación mecánica. Los estudios indicaron recomendaciones de cuño preventivo, asistencial y farmacológico.

Conclusiones:

las manifestaciones clínicas, las complicaciones y los tratamientos/cuidados asistenciales a las personas coinfectadas por SARS-CoV-2/VIH se asemejan a los de la población en general. La coinfección, vía de regla, no indica peor pronóstico.

Descriptores:
Infecciones por Coronavirus; Pandemias; VIH; Síndrome de Inmunodeficiencia Adquirida; Enfermedades Transmisibles

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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