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1.
Topics in Antiviral Medicine ; 30(1 SUPPL):297-298, 2022.
Article in English | EMBASE | ID: covidwho-1881011

ABSTRACT

Background: Asymptomatic COVID-19 is common among the general population, but little has been reported on this phenomenon among people with HIV (PWH) globally. Here we present data on a representative subset of 2,464 REPRIEVE participants with blood collected for COVID-19 serology from May 2020 to February 2021. Methods: REPRIEVE is an international primary atherosclerotic cardiovascular disease (ASCVD) prevention RCT of pitavastatin calcium vs. placebo among 7,770 PWH ages 40-75 on antiretroviral therapy (ART). Beginning in April 2020, targeted data on COVID-19 diagnosis and symptoms were collected as part of routine trial visits every 4 months, and blood was collected annually to assess SARS-CoV-2 serology. SARS-CoV-2 infection was defined as either presence of SARS-CoV-2 IgG or IgA RBD protein (anti-spike) antibodies or reporting of confirmed COVID-19 disease prior to the date of antibody sampling in the absence of prior COVID-19 vaccine receipt. We distinguished symptomatic from asymptomatic disease based on completed COVID-19 symptom questionnaire. Demographic, cardiometabolic, and HIV-specific data are described among those with symptomatic versus asymptomatic COVID-19 disease. Results: Participant characteristics (n=2464) included median age 53 years, 35% female sex, 47% Black or African American race, median CD4 count 649 c/mm3, and 97% with HIV VL <400 cp/mL. SARS-CoV-2 infection occurred in 318 persons (13%): 58 with clinical disease diagnosis and 260 with reactive Abs but no reported clinical disease. Of these persons, 304 completed symptom questionnaires: 120 (39%) reported at least 1 symptom of COVID-19 disease, but 184 (61%) reported no symptoms. PWH with asymptomatic infection were more likely to be from non-High Income Regions, of Black or African American race, and to be non-obese (Table). Median ASCVD risk score was <5% (low risk) for the two groups. Potential differences in symptomatic disease based on ART-regimen were noted, but no clinical differences between the groups for CD4 counts or HIV viral suppression were observed. Conclusion: Asymptomatic SARS-CoV-2 infection is very common among ART-treated PWH globally. With Ab testing, we determined that 61% of COVID-19 infections were asymptomatic in the REPRIEVE cohort, similar to rates reported in the general population. HIV clinicians must remain vigilant about COVID-19 testing among PWH to assure that asymptomatic cases are identified.

2.
Topics in Antiviral Medicine ; 30(1 SUPPL):19, 2022.
Article in English | EMBASE | ID: covidwho-1880234

ABSTRACT

Background: Little is known regarding global COVID-19 vaccination rates in people with HIV (PWH), a population with significant morbidity from COVID-19. The Randomized Trial to Prevent Vascular Events (REPRIEVE) is a global primary cardiovascular prevention trial among PWH (N=7770) with representation from >100 sites across twelve countries (Brazil, Botswana, Canada, Haiti, India, Peru, Spain, South Africa, Thailand, Uganda, USA, Zimbabwe). Data collected on COVID-19 vaccination rates in REPRIEVE afford a unique opportunity to assess such rates among PWH across global regions. Methods: We assessed cumulative COVID-19 vaccination rates from January through July 2021 among 6952 active participants and compared rates to region-and country-specific vaccination data among the general population, determined from publicly available datasets (CDC, World Bank). Secondarily, within the REPRIEVE cohort, demographic, cardiovascular, and HIV-specific data were compared among those vaccinated vs not via Kaplan-Meier. Results: The cumulative probability of COVID-19 vaccination through the end of July 2021 was 47% among REPRIEVE participants, with rates varying substantially by global burden of disease (GBD) super-region and specific countries. Cumulative vaccination rates (Figure) were highest in the High-Income super-region (64%), followed by Latin America and the Caribbean (51%), Southeast/East Asia (36%), South Asia (16%) and Sub-Saharan Africa (12%). Country-specific rates varied dramatically, with vaccination rates highest in the United States, Peru, and Brazil, 67%, 60%, and 55%, and lowest in South Africa, Uganda, and Haiti with 11%, 3%, and 0%, respectively. Overall factors associated with COVID-19 vaccination among PWH included age, White race, natal male sex, BMI, and higher burden of cardiovascular risk factors, with important differences across GBD super-regions by log-rank test. Vaccination rates among PWH in REPRIEVE were largely comparable to the general population, in most GBD super-regions (Figure), though differences were observed in comparison to the general population in specific countries (data not shown). Conclusion: Global inequities in COVID-19 vaccine access among PWH are apparent, with highest vaccination rates observed among those residing in high-income regions. In addition to region, factors associated with vaccination among PWH included White race, natal male sex, and higher burden of CVD risk factors. Efforts are needed to increase global and regional vaccine rates for PWH.

3.
Open Forum Infectious Diseases ; 8(SUPPL 1):S264-S265, 2021.
Article in English | EMBASE | ID: covidwho-1746675

ABSTRACT

Background. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has led to increased hospitalizations and utilization of critical care services. There are few studies describing co-morbidities and demographics associated with patients re-admitted within 30-days of discharge. The purpose of this study is to describe this patient population. Methods. This was a single-center, retrospective study at The Ohio State University Wexner Medical Center to identify patients who were admitted secondary to SARS-CoV-2 and required readmission within 30 days due to complications that might be associated with COVID-19. Adults admitted between 3/15/2020 and 11/15/2020 were included in this study. Baseline demographics including age, gender and race in addition to select comorbidities were identified. Results. 250 patients were identified who were readmitted for various reasons. Readmitted patients had a median age of 55 years, 44% were male, and 41.2% were Black/African American. 62.4% of the population was obese (BMI ≥30 kg/m2) with 21.6% with a BMI ≥ 40 kg/m2. The top three co-morbidities seen included Diabetes Mellitus (DM) (32.2%), Hyperlipidemia (48.3%) and Hypertension (51.7%). Conclusion. Though this study lacked a comparator group, it is clear that patients readmitted with all cause etiologies were disproportionally Black/African-American and obese, with a high prevalence of DM, hyperlipidemia, and hypertension. We recommend close monitoring of patients in these groups to reduce COVID19 readmissions. This is the first step in identifying which patients may be more likely to develop complications and required readmission, the next step is to compare these patients to those that were not readmitted to develop a risk model for readmission.

4.
Open Forum Infectious Diseases ; 8(SUPPL 1):S369, 2021.
Article in English | EMBASE | ID: covidwho-1746462

ABSTRACT

Background. Limited options currently exist for treatment of patients diagnosed with symptomatic coronavirus 2019 (COVID-19). Monoclonal antibody therapy (MAT) has been investigated as a therapeutic option for symptomatic COVID-19 patients in the outpatient setting at high-risk for progression to severe disease based on emergency use authorization (EUA) criteria. No published studies have compared outcomes for patients treated with different MAT for COVID-19. Methods. This was a single-center, retrospective cohort study at The Ohio State University Wexner Medical Center to compare COVID-19-related emergency room (ER) visits, admissions, and mortality at 30 days after MAT infusion for adult patients with symptomatic SARS-CoV-2 between November 16, 2020 and February 2, 2021 who received bamlanivimab versus those who received casirivimab-imdevimab. Statistical analysis used logistic regression analysis to determine the odds ratio (OR) to evaluate the relationship between patient characteristics, MAT, and outcomes. Results. The cohort included 943 patients with SARS-CoV-2 who received MAT, including 658 patients who received bamlanivimab and 285 who received casirivimab-imdevimab. Outcome results between patients who received bamlanivimab and casirivimab-imdevimab showed no statistically significant difference seen in the number of COVID-19 related ER visits (3.2% vs 3.5%, p = 0.80), hospital admissions (4.6% vs 2.8%, p = 0.21), or mortality (0.5% vs 0.7%, p = 0.63). Multivariate analysis showed no statistically significant difference in outcomes between the groups when accounting for potential confounders. As reflected in the Table, chronic lymphocytic leukemia (CLL), gender, and asthma were associated with increased COVID-19 related ER visit within 30 days of infusion and age, chronic obstructive pulmonary disease, CLL, and lupus were associated with increased risk for COVID-19 related admission within 30 days of infusion. Age and obesity with body mass index greater than 35 mg/ kg2 were associated with increased risk for COVID-19 related mortality at 30 days. Conclusion. COVID-19 related outcomes were similar when comparing patients with COVID-19 treated with bamlanivimab versus those treated with casirivimab-imdevimab.

5.
Open Forum Infectious Diseases ; 8(SUPPL 1):S379, 2021.
Article in English | EMBASE | ID: covidwho-1746445

ABSTRACT

Background. Monoclonal antibody therapy (MAT) was granted Emergency Use Authorization (EUA) by the U.S. Food and Drug Administration for treatment of mild to moderate coronavirus disease 2019 (COVID-19) in adults with positive SARSCoV-2 viral testing and at high risk for progression to severe COVID-19 with up to 10 days of symptoms. This study assessed the impact of MAT on COVID-19-related ER visits, admissions, and mortality for patients diagnosed with COVID-19. Methods. This was a single-center, retrospective study at The Ohio State University Wexner Medical Center to compare COVID-19-related ER visits, admissions, and mortality at 30 days after receiving MAT in the outpatient setting with either bamlanivimab or casirivimab-imdevimab in adult patients diagnosed with SARS-CoV-2 between November 16, 2020 and February 2, 2021. Outcomes in patients who received MAT were compared to those of a control group of patients diagnosed with COVID-19 in the outpatient setting from May 16, 2020 through November 15, 2020 who would have qualified for MAT through EUA criteria had it been available. Statistical analysis used logistic regression analysis with backward selection to determine the odds ratios (OR) and the 95% confidence interval to evaluate the relationship between patient clinical characteristics and outcomes. Results. This study cohort included 1,944 patients, including 943 who received MAT and 1,001 in the control group. The MAT group included 658 who received bamlanivimab and 285 who received casirivimab-imdevimab. Patients who received MAT compared to the control group had a lower rate of COVID-19 related ER visits (3.3% vs 7.4%, p = < 0.0001) and hospital admissions (4.0% vs 7.8%, p = < 0.0001). No statistically significant difference was seen in mortality between the MAT group (0.5%) and control group (1.1%, p = 0.17). After accounting for potential confounders, the difference between the monoclonal antibody and control groups remained significant for ER visits and hospital admissions as reflected in the table. Conclusion. Patients who received MAT for COVID-19 in the outpatient setting had a lower rate of COVID-19-related 30 day ER visits and hospitalizations compared to those who did not receive MAT, adjusting for potential confounders.

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