ABSTRACT
Background: COVID-19, the disease caused by SARS-CoV-2, has resulted in devastating morbidity and mortality worldwide. Alarming evidence indicates that long-term adverse outcomes of COVID-19 can affect all major systems of the body, including the immune, respiratory, cardiovascular, and neurological systems. While acute COVID-19 pathology does not appear to be markedly different by HIV status, long-term outcomes of COVID-19 in People with HIV (PWH) are unknown and require further investigation. This study evaluates the inflammatory profile longitudinally up to three months after COVID-19. In addition, markers of the blood-brain barrier (BBB) integrity and vascular dysfunction were also evaluated. Method(s): Plasma samples were collected from 15 males and 6 females with COVID-19 and HIV infection (COVID+/HIV+) and 9 males and 14 females with COVID-19 without HIV infection (COVID+/HIV-) between March 2020 and March 2021. Baseline samples were obtained approx. 10 days after COVID-19 diagnosis (T=0) and three months after (T=3). Mean age group for COVID+/HIV-was 45.4+/-17.8 years for males and 39.7+/-15.3 for females and for COVID+/HIV+ was 52.1+/-12.3 for males and 48.7+/-1 for females (N=15 and 6, respectively). 27 inflammatory molecules were measured by Bio-Plex Multiplex Immunoassay (Bio-Rad) and two markers of BBB and vascular dysfunction (soluble ICAM1 and S100beta) by ELISA. Result(s): Out of 27 inflammatory analytes, 20 had detectable signals. Eotaxin (CCL11) and G-CSF levels were differentially upregulated in the COVID+/HIV+ group as compared to the COVID+/HIV-group in both time point studied (Table 1). IFN-g showed sustained increased levels at T=3 in the COVID+/HIV+ group, whereas there was a significant reduction over time in the COVID+/HIV-group. At T3, inflammatory markers (IL-4, IL-8, IL-13, basic FGF, TNF-alpha, MIP-1alpha, and CCL2) either decreased or remained unchanged in both groups. In contrast, the markers of the BBB disruption and vascular dysfunction, such as S100beta and soluble ICAM-1 increased in the COVID+/HIV+ group, suggesting long-term progressive BBB and vascular alterations. Conclusion(s): HIV-1 may potentiate long COVID-19-induced neuropathology, with progressive BBB breakdown and sustained increase in eotaxin-1 and G-CSF. Plasma inflammatory markers in COVID-19 patients with or without HIV-1 co-infection.
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Purpose: The purpose of this study was to evaluate long term humoral and cellular immunity generated following SARS-CoV-2 infection in solid organ transplant recipients (SOTR). Method(s): Patients included had an active graft of an organ transplant as an adult, a positive polymerase chain reaction nasopharyngeal swab for SARS-CoV-2 after transplant, and had not received convalescent plasma, vaccination, or monoclonal antibody for SARS-CoV-2. Whole blood was obtained 6 months (+/- 1 month) after infection. Serology measured IgG and IgM titer to the SARS-CoV-2 spike protein receptor binding domain, reported as signal/ cut-off ratio (s/co). CD4+ and CD8+ T-cell reactivity was measured by Activation Induced Marker assays following stimulation of peripheral blood mononuclear cells with SARS-CoV-2 peptide pools encompassing the SARS-CoV-2 spike protein. Result(s): Of 25 subjects, 19 (76.0%) were hospitalized, 4 (16.0%) developed hypoxia, but none required mechanical ventilation. Biopsy-proven graft rejection occurred in 3 (12.0%), but none had graft loss. At 6 months, 8 (16%) had persistent symptoms and 2 (4.0%) were re-infected within one year. In the immunity study, 22 (88.0%) had reactive IgG testing and 11 (44.0%) had reactive IgM testing. Median IgG titer was 3.68 s/co (range 0.19-36.44) and IgM titer was 0.79 s/co (range 0.02-16.41). Virus-specific CD4+ T-cell reactivity was noted in 23 (92%), but only 10 (40.0%) had reactive CD8+ T-cell testing. Moderate correlation was observed between IgG and IgM titer (r=.51, p= 0.009) and between IgG titer and percent virus-specific CD4+ T-cells (r=.46, p=0.02). CD8+ T-cell reactivity was correlated with greater illness severity (p=0.043). Use of Tacrolimus, mycophenolate, or corticosteroids at time of infection was not associated with T-cell or antibody reactivity. Conclusion(s): In summary, this cohort of SOTR evaluated six months after noncritical COVID-19 illness demonstrated robust IgG and CD4+ T-cell responses, and CD8+ T-cell reactivity was correlated with higher disease severity.
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Background: Women have reported increased menstrual irregularities during the COVID-19 pandemic. It is unknown if this is due to biological (i.e., the effect of SARS-CoV-2 infection or vaccination) and/or psychosocial factors. This study examined menstrual irregularities during the COVID-19 pandemic and the association of abnormal menses with the presence of SARS-CoV-2 antibodies, stress, and mental health among reproductive age women. Methods: A cross-sectional study of 182 HIV-negative, sexually active, 18-to 45-year-old cisgender women was conducted on biobehavioral factors influencing HIV risk. From January 2019 to September 2021, participants completed a survey of menstrual irregularities over the previous three months, previous month condomless vaginal intercourse, and plans to conceive. Starting October 2020, SARS-CoV-2 IgG antibodies were measured using an FDA EUA rapid test assay using whole blood, and participants completed the Centers for Epidemiological Studies Depression Scale, the Loneliness Brief Form, the Perceived Stress Scale. History of COVID-19 vaccination was self-reported. Menstrual irregularities were compared by recruitment date (pre-pandemic vs. during pandemic/after April 2020) and by IgG antibody status. Logistic regression models tested if the presence of antibodies was associated with menstrual irregularities when controlling for age (in all models) and stress, depression, and loneliness in separate models. Results: Key variables are illustrated in Table 1. Menstrual irregularities did not differ by enrollment date. About half of women (n=36) had detectable IgG;5 had been vaccinated. Controlling for age, women with detectable IgG had 7.3, 95% CI [1.5, 36.5], times the odds of menstrual irregularities. Neither age, stress, nor mental health were associated with irregular menstruation. Among unvaccinated women (n=31), 35% with IgG antibodies had irregular menstruation compared to 0% without IgG antibodies. Among women with no plans to conceive, 74% had condomless intercourse, of whom 11% had irregular menstruation. Conclusion: Findings suggest a relationship between SARS-CoV-2 infection and irregular menstruation that was not accounted for by stress or mental health. During the COVID-19 pandemic, increased condom use and routine pregnancy testing may be merited among women not intending to conceive.
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Background. The Coronavirus disease of 2019 (COVID-19) global health crisis has resulted in an unprecedented strain on healthcare systems, reorganization of medical training programs and disruption in professional and personal lives of medical trainees. The impact of COVID-19 on infectious disease (ID) fellows, who are frontline healthcare professionals, has not been assessed. Methods. We conducted a national survey of adult and pediatric ID fellows to assess impact on educational activities, availability of personal protective equipment (PPE), well-being, and career prospects. Anxiety and burnout were assessed by 7-item generalized anxiety disorder scale and abbreviated Maslach burnout inventory respectively. Invitations to participate in the survey were sent via email to all ID fellows through Accreditation Council for Graduate Medical Education (ACGME) fellowship directors. Survey responses collected from August 1 to September 30, 2020 have been reported. Results. 136 fellows completed the survey (Table 1). 84% reported their institution had provided evidence-based didactics for management of COVID-19 and 53% indicated their general ID didactics were affected by the pandemic. 86% of fellows were involved in care of patients with COVID-19, and 31% reported a shortage of PPE affecting their clinical duties. Those living in highly impacted states (CA, FL, NY, TX) at the time of the survey were 1.70 times as likely to experience moderate to severe anxiety (vs. minimal to moderate) than those in other states;similarly, those who saw ≥11 COVID-19 patients weekly and reported PPE shortages were 2.5 and 2.0 times as likely, respectively, to experience moderate to severe anxiety compared to their peers who took care of 10 or fewer COVID-19 patients and did not experience PPE shortages. Burnout scores were not significant (Table 2). Conclusion. It is imperative that ID fellows feel adequately protected and supported during this pandemic. Pandemic preparedness should be included in the ID fellowship curriculum. Interventions for anxiety and burnout reduction should be implemented. ID fellowship programs should continue to accept feedback from fellows to ensure their ongoing safety, well-being, and education as we navigate this pandemic.
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Historically, the province of Cordoba was one of the wealthiest territories in the region of Andalusia, Spain, and left behind a rich heritage that is still largely unknown. Our research team has studied this cultural heritage and developed initiatives for its digitization that have been very successful in transmitting these assets to society. During the current COVID-19 pandemic, the projects have proven to bring numerous socio-economic benefits. In this paper, we discuss the virtualization of this heritage and present the results of the various digital interventions carried out in the province of Cordoba to consolidate a digital landscape that is publicly accessible. © 2021. All Rights Reserved.
ABSTRACT
Background: Immune dysfunction characterized by lower antibody (Ab) response to infection or vaccination has been well described among People Living with HIV (PLWH), but due to the novelty of the SARS-CoV-2 virus has not been evaluated among PLWH coinfected with SARS-CoV-2. This study compared the magnitude and longevity of Ab response to SARS-CoV-2 in a group of HIV+ and HIV-individuals infected with SARS-CoV-2 Methods: 17 HIV+COVID+ and 19 HIV-COVID+ participants were recruited from the community as part of the ACTION study and followed longitudinally at day 14, 1 month and 3 months. HIV+ were on effective ART (plasma viral load <500 copies/ml). SARS-CoV-2 infection was confirmed by SARS-COV2 DNA PCR and rapid antibody test. All participants had mild/moderate COVID-19 without hospitalization. Antibody responses (IgG and IgM) were measured using an indirect in house developed ELISA using spike RBD antigen (courtesy, Scott Boyd, Stanford University) and the data are expressed as relative Ab units based on the positive control standard. Results: The median age of HIV+ participants was 55 (26-63) with 23.5% (4/17) females. The median age for HIV-was 38 (27-78) with 57.8% (11/19) females. Time from COVID-19 diagnosis was 26 days for HIV+ and 21 for HIV-. Mean CD4 count for the HIV+ participants was 859.5 ± 287.2 cells/μl. Longitudinal analysis did not show a significant reduction in Ab response at 3 months in either HIV+ or HIV-groups. Levels of SARS-CoV-2 RBD specific IgM and IgG responses did not differ significantly between HIV+ and HIV-at any timepoint although there was a trend of lower IgM and IgG responses at 3 months in both groups compared to entry levels. Age was correlated with IgG response at day 14 (r =0.6, p = 0.02), 1 month (r =0.6, p = 0.014) and 3 month(r =0.87, p = 0.0008) in HIV+ and weakly correlated at day 14 (r =0.46, p = 0.04) in HIV-. Absolute CD4 count was not correlated with IgM and IgG responses in HIV+. Conclusion: The magnitude and persistence of Ab response to SARS-CoV-2 infection in the 3-4 months post-infection does not differ by HIV status. Although extended longitudinal follow-ups are required to gain insights about the longevity of Ab responses in HIV+ individuals, results suggest that immune protection and vaccine responses may not differ by HIV status.
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Background: The Coronavirus disease of 2019 (COVID-19) global health crisis caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in unprecedented mortality, impacted society, and strained healthcare systems, yet sufficient data regarding treatment options are lacking. Convalescent plasma, used since 1895 for infectious disease outbreaks, offers promise as a treatment option for COVID-19. Methods: This is a retrospective study of patients diagnosed by a nasopharyngeal swab SARS-CoV-2 reverse transcriptase-polymerase chain reaction (RT-PCR), who received convalescent plasma between April to June 2020 at two large hospitals in Miami, Florida, as part of the US FDA Expanded Access Program for COVID-19 convalescent plasma (CCP). Results: A total of 23 patients received CCP, 13 (57%) had severe COVID-19 disease, while 8 (35%) had critical or critical with multiorgan dysfunction. Median time of follow up was 26 (range, 7-79) days. Overall, 11 (48%) survived to discharge, 6 (26%) died, while 6 (26%) are currently hospitalized. All deaths reported were due to septic shock from secondary infections. 15 (65%) showed improvement in oxygen requirements 7 days post CCP transfusion. Measured inflammatory markers, c-reactive protein, lactate dehydrogenase, ferritin and d-dimer improved 7 days post transfusion in 13 (57%) patients. No adverse events due to the transfusion were reported. 10 (43.4%) patients had a negative SARS-CoV-2 RT-PCR at a median of 14.5 (range, 4-31) days after receiving convalescent plasma. Conclusion: Administration of convalescent plasma was found to be safe, with favorable outcomes in this small cohort of relatively high acuity patients. Larger studies including control arms are needed to establish the efficacy of convalescent plasma on clinical and virologic outcomes for patients with COVID-19. (Table Presented).
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Background: As the COronaVIrus Disease 2019 (COVID-19) continues to unfold, drastic changes in daily life pose significant challenges on mental and clinical health. While public health interventions such as national lockdowns and social distancing are enforced to reduce the spread of COVID-19, the psychosocial and physical consequences have yet to be determined that may disproportionately affect people living with HIV (PLWH). Methods: To evaluate the impact of COVID-related stress on mental and clinical health, we conducted a 20-minute questionnaire eliciting sociodemographic information, clinical and psychological factors from people living in Miami, Fl. All individuals >18 years with or without a history of COVID-19 were included. Participating PLWH were recruited from an existing HIV registry and HIV uninfected participants from community flyers and word of mouth. Results: A total of 135 participants were recruited from 05/2020-06/2020. The mean age was 50 years old, 73/135 (54%) were female, and 102/135 (75%) were PLWH. Among participating PLWH, 60/102 (58.8%) self-identified as African American, and 9/102 (8.8%) were positive for COVID-19 by a commercially approved test. Among HIV-negative participants, 15/33 (45.5%) self-identified as White and 11/33 (33%) were positive for COVID-19. Both PLWH and HIVnegative participants described significant disruptions in health care access (47%), difficulty paying basic needs (41%), and feelings of anxiety and depression (48%);there was no statistically significant difference by HIV status. However, HIV negative participants were less likely to experience job loss and income disruption compared to PLWH during the pandemic (70% for HIV-negative vs 48% for PLWH;OR 0.40, p=0.03). Conclusion: The impact of COVID-19 on emotional and clinical health is significant in both PLWH and HIV-negative groups. These findings highlight the need for providing mental and physical health care during the pandemic, especially for coping with stress and anxiety during these difficult times and ensuring adequate access to health care.