在住院的HIV感染者(PWH)中,与HIV阴性个体相比,住院PWH中的COVID-19死亡风险增加。有证据表明,tocilizumab-一种人源化单克隆白介素(IL)-6受体抑制剂(IL-6ri)抗体-在部分重症住院的COVID-19患者中与皮质类固醇联合使用时具有适度的死亡率益处。缺乏托珠单抗在患有严重COVID-19的PWH中使用后的临床结果数据。
我们介绍了一个多国病例系列,包括18例患有COVID-19的PWH,在2020年4月至6月期间接受了IL-6ri治疗。四名患者接受了托珠单抗,六个Sarilumab,八个人接受了无证IL-6ri.在该系列的18名患者中,4(22%)的CD4计数<200个细胞/mm3;14(82%)的HIV病毒载量受到抑制。8名患者(44%)都被送进了ICU,接受继发感染治疗;5人患有确诊的生物体。在CD4计数<200细胞/mm3的4例患者中,有3例因继发感染而接受治疗,有2个确认的生物。总体结果较差-12名患者(67%)入住ICU,11(61%)需要机械通气,7人(39%)死亡。
在此例住院PWH合并COVID-19并在常用皮质类固醇之前给予IL-6ri的病例系列中,有重症患者继发或合并感染的报告。PWH的综合研究,特别是CD4计数<200个细胞,有必要评估使用IL-6ri后的感染和其他结果,特别是在共同施用皮质类固醇的情况下。
In hospitalized people with HIV (PWH) there is an increased risk of mortality from COVID-19 among hospitalized PWH as compared to HIV-negative individuals. Evidence suggests that tocilizumab-a humanized monoclonal interleukin (IL)-6 receptor inhibitor (IL-6ri) antibody-has a modest mortality benefit when combined with corticosteroids in select hospitalized COVID-19 patients who are severely ill. Data on clinical outcomes after tocilizumab use in PWH with severe COVID-19 are lacking.
We present a multinational
case series of 18 PWH with COVID-19 who were treated with IL-6ri\'s during the period from April to June 2020. Four patients received tocilizumab, six sarilumab, and eight received an undocumented IL-6ri. Of the 18 patients in the series, 4 (22%) had CD4 counts < 200 cells/mm3; 14 (82%) had a suppressed HIV viral load. Eight patients (44%), all admitted to ICU, were treated for secondary infection; 5 had a confirmed organism. Of the four patients with CD4 counts < 200 cells/mm3, three were treated for secondary infection, with 2 confirmed organisms. Overall outcomes were poor-12 patients (67%) were admitted to the ICU, 11 (61%) required mechanical ventilation, and 7 (39%) died.
In this
case series of hospitalized PWH with COVID-19 and given IL-6ri prior to the common use of corticosteroids, there are
reports of secondary or co-infection in severely ill patients. Comprehensive studies in PWH, particularly with CD4 counts < 200 cells, are warranted to assess infectious and other outcomes after IL-6ri use, particularly in the context of co-administered corticosteroids.