PB0114 - Human immunodeficiency virus (HIV) and Severe acute respiratory syndrome coronavirus 2 (SARS-COV-2): dangerous liaisons?

Background: Endothelial dysfunction and dysregulated cytokines occur in HIV and SARS-COV-2 infection with derangements of hemostasis resulting in mortality. Thromboses in all compartments of the vascular tree occur in infected patients. Some publications on the interaction between SARS-CoV-2 and HIV suggest that HIV is not a risk factor for more severe outcomes.

Aims: Compare the presentation and outcomes of patients with secondary HIV-associated thrombotic thrombocytopenic purpura (TTP) without and with concomitant SARS-COV-2.

Methods: This was a nested study in an HIV-associated TTP cohort (N=17) at an academic hospital, CMJAH, in South Africa (Ethics M160134). Sequential patients with HIV-TTP admitted to CMJAH in 2020 underwent screening for SARS-CoV-2. Four co-infected patients were identified and compared to patients diagnosed with HIV-TTP without COVID.

Results: The median age and results of laboratory parameters were not significantly different between the HIV-TTP cohorts (p>0.01) (Table 1). The average days of plasma therapy were similar (median of 12 days). Two of the patients with COVID co-infection demised in hospital despite treatment.

Conclusion(s): Although there was a trend towards lower haemoglobin, platelet count and higher lactate dehydrogenase (LDH) and D-dimers in the COVID co-infected HIV-TTP cohort, these differences were not statistically significant. Outcomes were, however, worse with 2 of the 4 co-infected patients dying, one prior to the initiation of plasma therapy vs. no deaths in the HIV-TTP cohort without COVID. The reasons for the higher mortality are various and may include later presentation during strict lockdown, constraints placed on government hospitals and reduced access to critical therapy during the COVID pandemic. Importantly, there is some evidence that the clinical presentation is more severe in HIV/SARS-CoV-2 co-infection with secondary TTP although this is a small cohort. Further studies will examine levels of inflammatory biomarkers in SARS-CoV-2 and HIV-related TTP to determine the possible contribution of these coinfections in secondary HIV associated TTP.