Clinical course, management and outcomes of COVID-19 in HIV-infected renal transplant recipients: A case series
DOI:
https://doi.org/10.7196/SAMJ.2024.v114i3b.1374Keywords:
COVID-19, HIV, TransplantAbstract
Background. HIV‐infected kidney transplant recipients with COVID‐19 are at increased risk of acute illness and death owing to their underlying comorbidities and chronic immunosuppression.
Objectives. To describe the incidence, clinical presentation and course of COVID‐19, vaccination status, and SARS‐CoV‐2 antibody positivity rate among HIV‐infected‐to‐HIV‐infected kidney transplant recipients in South Africa (SA).
Methods. This retrospective study reports on rates of SARS‐CoV‐2 infection, COVID‐19 and mortality among SA HIV‐infected kidney transplant recipients who received organs from HIV‐infected donors (HIV positive to HIV positive), before and after vaccination. Patient demographics, clinical presentation, course, management and disease outcomes were analysed. Antibody serology tests were performed between May and September 2022.
Results. Among 39 HIV‐positive‐to‐HIV‐positive transplant recipients, 11 cases of COVID‐19 were diagnosed from March 2020 to September 2022. Six patients (55%) required hospitalisation, of whom 3 were admitted to a high‐care unit or intensive care unit. Two patients required mechanical ventilation, and 2 received acute dialysis. One patient was declined access to intensive care. Four patients (10%) died of COVID‐19 pneumonia. All the COVID‐19‐positive patients had at least one comorbidity. Vaccination data were available for 24 patients, of whom 5 had refused SARS‐CoV‐2 vaccination. SARS‐CoV‐2 antibody data were available for 20 patients; 4 vaccinated patients had a negative nucleocapsid protein antibody test and a positive spike protein antibody test, suggesting vaccination‐acquired immunity. The remaining 16 patients demonstrated immunity that was probably due to COVID infection, and of these, 14 were also vaccinated. Of the 11 COVID‐19 cases, only 1 was observed after vaccination.
Conclusion. In our case series, ~10% of the HIV‐positive‐to‐HIV‐positive transplant recipients died of COVID‐19 pneumonia. This mortality rate appears higher than figures reported in other transplant cohorts. However, it is likely that the actual number of cases of SARS‐CoV‐2 infection was much higher, as the study only included polymerase chain reaction‐confirmed cases. It remains unclear whether HIV infection, transplant or the combination of the two drives poorer outcomes, and larger studies adjusting for important demographic and biological factors may isolate these effects.
References
Cravedi P, Mothi SS, Azzi Y, et al. COVID‐19 and kidney transplantation: Results from the TANGO International Transplant Consortium. Am J Transplant 2020;20(11):3140‐3148. https://doi. org/10.1111/ajt.16185
Kates OS, Haydel BM, Florman SS, et al. Coronavirus disease 2019 in solid organ transplant: A multicenter cohort study. Clin Infect Dis 2021;73(11):e4090‐e4099. https://doi.org/10.1093/cid/ciaa1097
Mehta SA, Rana MM, Motter JD, et al. Incidence and outcomes of COVID‐19 in kidney and liver transplant recipients with HIV: Report from the National HOPE in Action Consortium.
Transplantation 2021;105(1):216‐224. https://doi.org/10.1097/TP.0000000000003527
Barbera LK, Kamis KF, Rowan SE, et al. HIV and COVID‐19: Review of clinical course and outcomes.
HIV Res Clin Pract 2021;22(4):102‐118. https://doi.org/10.1080/25787489.2021.1975608
Cooper TJ, Woodward B, Alom S, Harky A. Coronavirus disease 2019 (COVID‐19) outcomes in HIV/
AIDS patients: A systematic review. HIV Med 2020;21(9):567‐577. https://doi.org/10.1111/hiv.12911
Ssentongo P, Heilbrunn ES, Ssentongo AE, et al. Epidemiology and outcomes of COVID‐19 in HIV‐ infected individuals: A systematic review and meta‐analysis. Sci Rep 2021;11(1):6283. https://doi. org/10.1038/s41598‐021‐85359‐3
Jardim CGR, Zamani R, Akrami M. Evaluating the impact of the COVID‐19 pandemic on accessing HIV services in South Africa: A systematic review. Int J Environ Res Public Health 2022;19(19):11899. https://doi.org/10.3390/ijerph191911899
Rodrigo E, Miñambres E, Gutiérrez‐Baños JL, Valero R, Belmar L, Ruiz JC. COVID‐19‐related collapse of transplantation systems: A heterogeneous recovery? Am J Transplant 2020;20(11):3265‐ 3266. https://doi.org/10.1111/ajt.16125
Iwasaki A, Yang Y. The potential danger of suboptimal antibody responses in COVID‐19. Nat Rev Immunol 2020;20(6):339‐341. https://doi.org/10.1038/s41577‐020‐0321‐6
Lee ARYB, Wong SY, Chai LYA, et al. Efficacy of covid‐19 vaccines in immunocompromised patients: Systematic review and meta‐analysis. BMJ 2022;376:e068632. https://doi.org/10.1136/bmj‐2021‐068632
ZouS,WuM,MingF,etal.ImmuneresponseandsafetytoinactivatedCOVID‐19vaccine:Acomparison
between people living with HIV and HIV‐naive individuals. AIDS Res Ther 2022;19(1):33. https://doi.
org/10.1186/s12981‐022‐00459‐y
Muller E, Barday Z, Mendelson M, Kahn D. HIV‐positive‐to‐HIV‐positive kidney transplantation – results at 3 to 5 years. N Engl J Med 2015;372(7):613‐620. https://doi.org/10.1056/NEJMoa1408896
Yang W, Shaman JL. COVID‐19 pandemic dynamics in South Africa and epidemiological
characteristics of three variants of concern (Beta, Delta, and Omicron). eLife 2022;11:e78933. https://
doi.org/10.1101/2021.12.19.21268073
Naidoo R, Naidoo K. Prioritising ‘already‐scarce’ intensive care unit resources in the midst of COVID‐19: A call for regional triage committees in South Africa. BMC Med Ethics 2021;22(1):28. https://doi.org/10.1186/s12910‐021‐00596‐5
Elhadedy MA, Marie Y, Halawa A. COVID‐19 in renal transplant recipients: Case series and a brief review of current evidence. Nephron 2021;145(2):192‐198. https://doi.org/10.1159/000512329
Hamm SR, Rezahosseini O, Moller DL, et al. Incidence and severity of SARS‐CoV‐2 infections in liver and kidney transplant recipients in the post‐vaccination era: Real‐life data from Denmark. Am J Transplant 2022;22(11):2637‐2650. https://doi.org/10.1111/ajt.17141
Nikoloski Z, Alqunaibet AM, Alfawaz RA, et al. Covid‐19 and non‐communicable diseases: Evidence from a systematic literature review. BMC Public Health 2021;21(1):1068. https://doi.org/10.1186/s12889‐ 021‐11116‐w
Brown LB, Spinelli MA, Gandhi M. The interplay between HIV and COVID‐19: Summary of the data and responses to date. Curr Opin HIV AIDS 2021;16(1):63‐73. https://doi.org/10.1097/ COH.0000000000000659
Petersen LR, Sami S, Vuong N, et al. Lack of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) in a large cohort of previously infected persons. Clin Infect Dis 2021;73(9):e3066‐e3073. https://doi.org/10.1093/cid/ciaa1685
Ye Q, Zhang T, Lu D. Potential false‐positive reasons for SARS‐CoV‐2 antibody testing and its solution. J Med Virol 2021;93(7):4242‐4246. https://doi.org/10.1002/jmv.26937
European Centre for Disease Prevention and Control. Considerations for the use of antibody tests for SARS‐CoV‐2 – first update. 10 February 2022. https://www.ecdc.europa.eu/en/publications‐data/use‐ antibody‐tests‐sars‐cov‐2 (accessed 9 August 2022).
Parker A, Boloko L, Moolla MS, et al. Clinical features and outcomes of COVID‐19 admissions in a population with a high prevalence of HIV and tuberculosis: A multicentre cohort study. BMC Infect Dis 2022;22:559. https://doi.org/10.1186/s12879‐022‐07519‐8
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