BRIEF REPORT
Clinical Infectious Diseases
2276 • CID 2020:71 (15 October) • BRIEF REPORT
Received 20 April 2020; editorial decision 7 May 2020; accepted 11 May 2020; published online
May 14, 2020.
Correspondence: C. Gervasoni, Department of Infectious Diseases, ASST Fatebenefratelli
Sacco University Hospital, Via GB Grassi 74, 20157 Milano, Italy (cristina.gervasoni@unimi.it).
Clinical Infectious Diseases
®
2020;71(16):2276–8
© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society
of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
DOI: 10.1093/cid/ciaa579
Clinical Features and Outcomes
of Patients With Human
Immunodefciency Virus With
COVID-19
Cristina Gervasoni,
1,2
Paola Meraviglia,
1
Agostino Riva,
1
Andrea Giacomelli,
1
Letizia Oreni,
1
Davide Minisci,
1
Chiara Atzori,
1
Annalisa Ridolfo,
1
and
Dario Cattaneo
2,3
1
Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, Milan,
Italy,
2
Gestione Ambulatoriale Politerapie (GAP) Outpatient Clinic, ASST Fatebenefratelli Sacco
University Hospital, Milan, Italy, and
3
Unit of Clinical Pharmacology, ASST Fatebenefratelli
Sacco University Hospital, Milan, Italy
Little is known about the clinical outcomes of patients with
human immunodefciency virus infected with SARS-CoV-2.
We describe 47 patients referred to our hospital between 21
February and 16 April 2020 with proven/probable COVID-19,
45 (96%) of whom fully recovered and 2 who died.
Keywords. HIV; COVID-19; SARS-CoV-2; real-life; ob-
servational study.
As of April 20, the pandemic caused by severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2) infection had afected
2.5 million people all over the world, and led to more than
165 000 deaths (update available at https://coronavirus.jhu.edu/
map.html). Initial information from China and evidence ac-
cumulated over recent weeks has allowed the identifcation of
some of the risk factors associated with a negative prognosis,
including aging, male gender, hypertension, diabetes mellitus,
and cardiovascular, lung, and/or kidney diseases [1–4].
However, little is known about the impact of human immu-
nodefciency virus (HIV) infection on the clinical outcomes
of patients infected with SARS-CoV-2 because, to the best of
our knowledge, only case reports or small case series have so
far been published [5–7]. Treated people living with HIV who
have a normal CD4 T-cell count and suppressed viral load may
not be at increased risk of serious illness, but many also have
other conditions that increase their overall risk: almost half of
patients with HIV are males, aged more than 50 years, and af-
fected by chronic cardiovascular and lung diseases.
Te aim of this retrospective study was to describe the clin-
ical characteristics and outcomes of patients with HIV with a
probable/proven diagnosis of SARS-CoV-2 infection who have
been regularly followed up by our hospital.
METHODS
We searched our database for patients with HIV diagnosed as
having probable or proven SARS-CoV-2 infection between 21
February and 16 April 2020. A diagnosis of probable SARS-
CoV-2 infection was based on the presence of fever and res-
piratory symptoms (cough and dyspnea); epidemiological risk
factors, such as relatives or close colleagues with a proven diag-
nosis of coronavirus disease 2019 (COVID-19); and/or a chest
X-ray or computed tomography (CT) diagnosis of interstitial
pneumonia. Proven SARS-CoV-2 infection required a throat
swab positive for viral nucleic acid. We also recorded their main
demographic data, pharmacological treatments, and clinical
outcomes.
Te overall population frequency data were stratifed by
gender and expressed as absolute numbers: the other measures
are expressed as means ± SDs.
Tis retrospective study was conducted using data col-
lected for clinical purposes, all of which had been previously
made anonymous in accordance with the requirements of the
Italian Personal Data Protection Code (Legislative Decree No.
196/2003) and the general authorizations issued by the Italian
Data Protection Authority. Ethics committee approval was
unnecessary because Italian law states it is only required for
prospective clinical trials of medical products for clinical use
(Articles 6 and 9 of Legislative Decree No. 211/2003). All of the
patients gave their informed consent to the medical procedures
used for routine treatment purposes.
RESULTS
The database of our Department of Infectious Diseases in-
cluded nearly 6000 patients with HIV (74% males; mean age,
52 ± 12 years); 90% had less than 20 copies/mL of HIV viral
load and 76% had a CD4 cell count of greater than 500 cells/
mm
3
(3% had <200 cells/mm
3
). During the observation period,
47 patients with HIV with proven or probable SARS-CoV-2
infection were identified. They were mainly males (76%) and
had a mean age of 51 ± 11 years. As shown in Table 1, most
of the patients showed suppressed HIV viremia and acceptable
immune reconstitution (CD4 cell count >350 cells/mm
3
); 3 pa-
tients (all males) had detectable HIV viral loads of 52, 72, and
134 copies/mL. Nearly 64% had at least 1 comorbidity (82% of
males and 58% of females), mainly dyslipidemia (32%), arterial
hypertension (30%), and hepatitis B or hepatitis C coinfections
(11%). Approximately 80% of the identified patients were re-
ceiving integrase inhibitor-based antiretroviral treatment and