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Both typical and atypical radiological changes predict poor COVID-19 outcome in HIV-positive patients from a multinational observational study - data from Euroguidelines in Central and Eastern Europe Network Group

Background: In countries with limited resources, people living with HIV (PLWH) may differently present lung infections hindering the differential diagnosis and the choice of treatment during coronavirus disease 2019 (COVID-19). This study aims to investigate the association between radiological changes and poor COVID-19 outcome PLWH from Central and Eastern Europe. Methods: Since November 2020 ECEE Network Group have started collecting data on HIV/COVID-19 co- infection. In total data was submitted from 16 countries (eCRF) on 557 HIV+ patients. Analysis included patients with radiological examination performed. Logistic regression models were used to identify factors associated with death, ICU admission or partial recovery (poor COVID-19 outcome). Factors significant in univariate models (p<01 were included in multivariate model. Results: Radiological data were available for 224 (40.2%) patients, 108 (48.2%) had computed tomography and 116 (51.8%) chest X-ray. Of these 211 (94.2%) were diagnosed with RT-PCR, 212 (94.6%) were symptomatic, 123 (55.6%) were hospitalized, 37 (16.6%) required oxygen therapy and 28 (13.1%) either died, was admitted to ICU or only partially recovered. By radiologist’s description 138 (61.6%) patients had typical, 18 (8.0%) atypical and 68 (30.4%) no radiological changes. In univariate models, CD4 count (OR=0.86 [95% CI: 0.76- 0.98]), having a comorbidity (2.33 [1.43- 3.80]), co-infection with HCV and/or HBV (3.17 [1.32-7.60]), being currently employed (0.31 [0.13-0.70]), being on antiretroviral therapy (0.22 [0.08-0.63]) and having typical (3.90 [1.12- 13.65]) or atypical (10.8 [2.23-52.5]) radiological changes were significantly associated with poor COVID-19 outcome. In the multivariate model being on antiretroviral therapy (OR=0.20 [95% CI:0.05-0.80]) decreased the odds of poor COVID-19 outcome. Having a comorbidity (2.12 [1.20-3.72]), as well as both typical (4.23 [1.05- 17.0]) and atypical (6.39 [1.03-39.7]) radiological changes (vs. no changes) increased the odds of poor COVID-19 outcome. Conclusions: Among HIV patients diagnosed with symptomatic SARS-CoV-2 infection presence of both typical and atypical radiological COVID-19 changes independently predicted poorer outcome.

COVID-19 ; HIV positive ; radiology ; changes ; Euroguidelines

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