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Background: The impact of some antiretrovirals against SARS-CoV-2 infection and disease severity is conflicting. We evaluated the effect of tenofovir alafenamide/emtricitabine (TAF/FTC) and tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) against SARS-CoV-2 infection and associated clinical outcomes among people living with (PLWH). Methods: We conducted a propensity score-matched analysis leveraging data from the PISCIS cohort of PLWH in Catalonia (Spain). We matched for TAF/FTC versus ABC/3TC in a ratio of 1:1, and 1:3 for TDF/FTC versus ABC/3TC, and TDF/FTC versus TAF/FTC. We used logistic regression to assess the association between tenofovir-based ART and SARS-CoV-2 diagnosis and associated hospitalisation. Results: In our entire cohort [median age: 46.1 years, 82.3% males], 7550 PLWH were being treated with TAF/FTC, 1020 receiving TDF/FTC, and 4135 receiving ABC/3TC. After propensity score-matching, SARS-CoV-2 diagnosis rates were the same in TAF/FTC versus ABC/3TC recipients (12.2% vs 12.2%, P=1.00);lower among TDF/FTC versus ABC/3TC recipients (9.7% vs 12.4%, P=0.05) with borderline significance;and lower among TDF/FTC versus TAF/FTC recipients (9.7% vs 12.6%, P=0.03). In well-adjusted logistic regression models, TAF/FTC was not associated with reduced SARS-CoV-2 diagnosis (adjusted odds ratio [aOR] 0.97;95% confidence interval [CI], 0.83-1.12) or associated hospitalisation (aOR 0.95;95% CI, 0.62-1.45). TDF/FTC compared to ABC/3TC, was not associated with reduced SARS-CoV-2 diagnosis (aOR 0.81;95% CI, 0.61-1.07) or hospitalisation (aOR 0.49;95% CI, 0.14-1.27). TDF/FTC was not associated with reduced SARS-CoV-2 diagnosis (aOR 0.81;95% CI, 0.61-1.07) or associated hospitalisation (aOR 0.47;95% CI, 0.14-1.22) compared to TAF/FTC. Conclusion: TAF/FTC or TDF/FTC were not associated with reduced SARS-CoV-2 diagnosis rates or associated hospitalisations among PLWH. TDF/FTC users had baseline characteristics intrinsically associated with more benign SARS-CoV-2 infection outcomes. Tenofovir exposure or not should not modify the preventive or therapeutic SARS-CoV-2 infection management.
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OBJECTIVE: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), primarily targets the respiratory system. This study describes the characteristics associated with mortality among patients infected with SARS-CoV-2 at a single hospital in Baguio City, Philippines. METHODS: We reviewed medical records (including history, laboratory results and treatment regimen) of 280 confirmed COVID-19 patients admitted to a single hospital during March-October 2020. Clinical characteristics and outcomes (frequency and type of complication, recovery rate and mortality) were evaluated. Multiple logistic regression was used to analyse factors associated with mortality. RESULTS: The mean age of COVID-19 patients was 48.4 years and the female-to-male ratio was 1.8:1. Hypertension, cardiovascular disease (CVD) and diabetes were the most frequent comorbidities reported. Common presenting symptoms were respiratory and constitutional, with 41% of patients not reporting symptoms on admission. Patients with moderate, severe and critical disease comprised 45%, 8% and 4%, respectively. A total of 15% had complications, health care-associated pneumonia being the most frequent complication. The recovery rate was 95%; 5% of patients died, with multiorgan failure being the most common cause. The presence of CVD, chronic kidney disease, prolonged prothrombin time and elevated lactate dehydrogenase (LDH) were associated with mortality. DISCUSSION: Most COVID-19 patients in our population had asymptomatic to moderate disease on admission. Mortality from COVID-19 was associated with having CVD, chronic kidney disease, elevated LDH and prolonged prothrombin time. Based on these results, we emphasize that people should take all necessary precautions to avoid infection with SARS-CoV-2.
Subject(s)
COVID-19 , COVID-19/epidemiology , COVID-19/therapy , Female , Hospitalization , Humans , Male , Middle Aged , Philippines/epidemiology , Retrospective Studies , SARS-CoV-2 , Tertiary Care CentersABSTRACT
Objective: To determine the incidence, risk factors, clinical features, laboratory findings, management & fatality of ADEM in COVID-19 patients. Background: There has been a concerning increase in the prevalence of COVID-19 associated acute disseminated encephalomyelitis. ADEM is a rare autoimmune disorder, often post-viral, primarily attacks children and can potentially lead to long lasting neurological sequelae. As such, accurate diagnosis and timely management is of paramount clinical significance. Design/Methods: A systematic search adhering to PRISMA guidelines was performed from electronic databases (Medline, Google Scholar, OpenGray, Cochrane Library, NYAM) from inception until 12th October 2020. Renowned preprint servers like medRxiv, bioRxiv were also searched. Published case-reports/series of proven/presumed ADEM in COVID-19 patients were included. Results: Fourteen case-reports/series, with a sample size of 18 patients, were included. Mean age was 50.6±15.2 years, with a male to female ratio of 1:1. Most cases reported signs/symptoms of neurological nature prior to respiratory;the most common being: headaches, paresthesia, movement disorders, positive Babinski's sign and absent Deep tendon reflexes. Hypertension was the most common comorbidity. Eleven patients required intubation. Treatment with highdose corticosteroids and antibiotics/antivirals resulted in partial recovery of 66.6% of cases. Corticosteroids plus IVIG therapy aided in partial recovery of 27.7% of cases. Plasmapheresis was limited to 4 patients. SARS-CoV2 was reported in CSF samples of 11.1% patients. Partial recovery was seen in 88.8% and in-hospital mortality was reported in 11.1% of patients. Full clinical response was not seen. Conclusions: Neurological symptoms were the main presentation of COVID-19 which did not correlate with the severity of respiratory symptoms. High incidence of ADEM with hemorrhage (n=3) is striking. A rise in the prevalence of ADEM in adults in contrast to children is also concerning. Brain inflammation is likely caused by immune response to the disease rather than neurotropism. Clinicians need to be vigilant as early diagnosis can improve patient outcomes.
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Background: Currently, there are no biomarkers to predict respiratory worsening in patients with Coronavirus infectious disease, 2019 (COVID-19) pneumonia. Objectives: We aimed to determine the prognostic value of Krebs von De Lungen-6 circulating serum levels (sKL-6) predicting COVID-19 evolving trends. Methods: We prospectively analyzed the clinical and laboratory characteristics of 375 COVID-19 patients with mild lung disease on admission. sKL-6 was obtained in all patients at baseline and compared among patients with respiratory worsening. Results: 45.1% of patients developed respiratory worsening during hospitalization. Baseline sKL-6 levels were higher in patients who had respiratory worsening (median [IQR] 303 [209-449] vs. 285.5 [15.8-5724], P=0.068). The best sKL-6 cut-off point was 408 U/mL (area under the curve 0.55;33% sensitivity, 79% specificity). Independent predictors of respiratory worsening were sKL-6 serum levels, age >51 years, time hospitalized, and dyspnea on admission. Patients with baseline sKL-6 ≥ 408 U/mL had a 39% higher risk of developing respiratory aggravation seven days after admission. In patients with serial determinations, sKL-6 was also higher in those who subsequently worsened (median [IQR] 330 [219-460] vs 290.5 [193-396];p<0.02). Conclusion: sKL-6 has a low sensibility to predict respiratory worsening in patients with mild COVID-19 pneumonia. Baseline sKL-6 ≥ 408 U/mL is associated to a higher risk of respiratory worsening. sKL-6 levels are not useful as a screening tool to stratify patients on admission but further research is needed to investigate if serial determinations of sKL-6 may be of prognostic use.
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Purpose: The COVID-19 pandemic has disrupted rural American Indian populations disproportionately in terms of elevated infection rates, economic hardship and psychosocial stressors. As Kirsch et al. (2020), Dumas et al. (2020) and others have noted, social distancing efforts to contain the spread of the virus exacerbate risk factors for substance use in youth, including social isolation, boredom and depression. Historical trauma, socioeconomic inequalities and geographic isolation already challenge Tribal-community-partnered interventions to reduce and prevent underage substance use in rural California Native communities. We describe innovative ways one program addressed the additional challenges of pandemic conditions. Methods and Data: Tribal clinic providers and partnering research scientist met weekly to design, implement, and evaluate a multilevel intervention which combined clinic-based behavioral programs to reduce individual demand for alcohol and other drugs with community-based environmental strategies to reduce social supply of alcohol and other drugs. Research staff meetings were recorded in written logs. Using an extended case study approach, we conducted thematic review of weekly activity logs for the period of March through December 2020. Results: Recurring themes included responding to community emergency concerns, leveraging prior relationships, and creatively expanding technological capabilities while adhering to the underlying model of the multilevel intervention. Staff participated in drive-through medication pick-ups, virtual and drive-through events promoting resources and mental health as well as informal wellness checks with community partners and study participants through virtual outreach. The intervention's clinic component was shifted from in-person to online meetings on a secure web-based platform using Tribal IRB-approved digital signatures for parental consent and youth assent. The environmental prevention component enhanced educational messaging in lieu of in-person presentations. Conclusions: Transitioning to virtual intervention activities to reduce underage drinking and drug use among American Indian youth facilitated deeper relationship-building within the community. Expanded technology applications enabled the project to continue serving remote communities. These innovations present novel ways for clinics serving rural, reservation-dwelling, Tribal youth to treat, reduce, and prevent underage substance use and other tribal health disparities in the time of a pandemic health emergency and otherwise.