TY - JOUR
T1 - Clinical outcomes after IL-6 blockade in patients with COVID-19 and HIV
T2 - a case series
AU - HIV-COVID-19 Consortium
AU - Minkove, Samuel J.
AU - Geiger, Grant
AU - Llibre, Josep M.
AU - Montgomery, Mary W.
AU - West, Natalie E.
AU - Chida, Natasha M.
AU - Antar, Annukka A.R.
AU - Dandachi, Dima
AU - Weld, Ethel D.
AU - Karmen-Tuohy, Savannah
AU - Carlucci, Philip M.
AU - Zacharioudakis, Ioannis M.
AU - Rahimian, Joseph
AU - Zervou, Fainareti N.
AU - Rebick, Gabriel
AU - Stachel, Anna
AU - Tang, Shini
AU - Ding, Dan
AU - Jones, Joyce L.
AU - Farley, Jason E.
AU - Dooley, Kelly E.
AU - Wilgus, Barbara E.
AU - Sanchez, Michael
AU - Chow, Jeremy
AU - Kitchell, Ellen
AU - Koh, Shannon
AU - Maxwell, Daniel
AU - Lau, Abby
AU - Brooks, Shamika
AU - Chu, Jessica
AU - Estrada, Joshua
AU - Lazarte, Susana M.
AU - Arinze, Folasade
AU - Francis, Adero
AU - Paranjape, Neha
AU - Sax, Paul E.
AU - Wanjalla, Celestine N.
AU - Kheshti, Asghar N.
AU - Bailin, Samuel
AU - Koethe, John
AU - Kelly, Sean G.
AU - Raffanti, Stephen P.
AU - Patel, Shital M.
AU - Xu, Teena Huan
AU - Goebel, Melanie
AU - Santiago, Alberto Díaz De
AU - Ray, Manoj
AU - Slim, Jihad
AU - Kratz, Ann Marie Porreca
AU - Koren, David E.
N1 - Funding Information:
New York University Grossman School of Medicine, NY: Savannah Karmen-Tuohy, BS; Philip M. Carlucci, BS; Ioannis M. Zacharioudakis, MD; Joseph Rahimian, MD; Fainareti N Zervou, MD; Gabriel Rebick, MD; Anna Stachel, Ph.D.; Shini Tang, BS; Dan Ding, MA. Johns Hopkins University, MD: Joyce L Jones, MD, MS; Jason E. Farley, Ph.D., MPH; Kelly E. Dooley, MD, Ph.D. Barbara E. Wilgus, MSN, CRNP; Michael Sanchez, DNP, CRNP, FNP-BC, FAANP. UT Southwestern Medical Center/Parkland Memorial Hospital, TX, USA: Jeremy Chow, MD, MS; Ellen Kitchell, MD; Shannon Koh, MD; Daniel Maxwell, MD; Abby Lau, MD; Shamika Brooks APRN, FNP-C, AAHIVS; Jessica Chu, PA-C; Joshua Estrada, PA-C, AAHIVS, and Susana M. Lazarte, MD. Wellstar Kennestone Regional Medical Center, GA: Folasade Arinze, MD, MPH; Adero Francis, MD; Neha Paranjape, MD, MPH. Brigham and Women's Hospital, MA: Paul E. Sax, MD. Vanderbilt University Medical Center, TN: Celestine N. Wanjalla MD, PhD; Asghar N. Kheshti, Samuel Bailin MD, John R. Koethe MD, Sean G. Kelly MD, Stephen P. Raffanti MD. Baylor College of Medicine, TX: Shital M. Patel, MD, MS; Teena Huan Xu, MD; Melanie Goebel, MD. Infectious Diseases and Fight AIDS Foundation, University Hospital Germans Trias, Badalona, Spain. Puerta de Hierro Majadahonda University Hospital, Madrid, Spain: Alberto Díaz-De Santiago, MD, Ph.D. Santa Clara Valley Medical Center, CA: Manoj Ray, MD; Carol Hu, MD. Saint Michael's Medical Center, NJ: Jihad Slim, MD. Tower Health, PA: Ann Marie Porreca Kratz, PharmD, BCPS, BCIDP. Temple University Health System, PA: David E. Koren, PharmD; Kayla Hiryak, PharmD. The University of Arkansas for Medical Sciences, AR: Brannon Hill, PharmD; Ryan K Dare, MD, MS; Stacie Bordelon, PharmD, AAHIVP; Brett Bailey, PharmD. University of Maryland, MD: John W. Baddley, MD, MSPH. University of Kansas Medical Center, KS: D. Matthew Shoemaker, DO. AMITA Health Saint Francis Hospital, IL: Guillermo Rodriguez-Nava, MD. Mayo Clinic College of Medicine, Rochester, MN: FNU Shweta, MBBS. The University of California, San Francisco Medical Center, CA: Carolyn Chu, MD, MSc; Catherine Pearson, MD. The Polyclinic, WA: Amy Treakle, MD. Case Western Reserve University, OH: Jennifer J. Furin, MD, Ph.D. MetroHealth Medical Center, OH: Milana Bogorodskaya, MD. Hackensack University Medical Center, NJ: Samit Desai, MD. Hurley Medical Center/Michigan State University College of Human Medicine, MI: Danielle Osterholzer, MD. San Joaquin General Hospital, CA: Jered Arquiette, PharmD, BCPS-AQ ID. University of Washington, WA: Emily S. Ford, MD. University of Maryland Medical Center Midtown Campus, MD: Patrick R. Ching, MD, MPH. Alexandra Hospital, National University Health System (NUHS), Singapore: Louisa Sun, MBBS, MRCP. Washington University, MO. Advocate Aurora St. Luke's Medical Center, WI: Brian P. Buggy, MD. Indiana University Health, IN: Amir Tirmizi, MD. Mount Sinai Hospital, IL: Sarah Argentine, NP. SOVAH health, VA: Balaji Desai, MD. Icahn School of Medicine at Mount Sinai, NY: Talia H. Swartz, MD, PhD. Callen-Lorde Community Health: Dusty Latimer, PA-C. University of Missouri, Columbia: Maraya Camazine, MS; Andres Bran, MD. The authors would like to acknowledge the HIV-COVID-19 consortium and the many contributors who helped with this work by enrolling their patients, and collecting data.
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - Background: 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. Case presentation: 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. Conclusions: 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.
AB - Background: 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. Case presentation: 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. Conclusions: 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.
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UR - http://www.scopus.com/inward/citedby.url?scp=85124501076&partnerID=8YFLogxK
U2 - 10.1186/s12981-022-00430-x
DO - 10.1186/s12981-022-00430-x
M3 - Article
C2 - 35148782
AN - SCOPUS:85124501076
SN - 1742-6405
VL - 19
JO - AIDS research and therapy
JF - AIDS research and therapy
IS - 1
M1 - 6
ER -