Clinical outcomes after IL-6 blockade in patients with COVID-19 and HIV: a case series
Por:
Minkove, SJ, Geiger, G, Llibre, JM, Montgomery, MW, West, NE, Chida, NM, Antar, AAR, Dandachi, D and Weld, ED
Publicada:
11 feb 2022
Resumen:
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/mm(3); 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/mm(3), 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.
Filiaciones:
Minkove, SJ:
Johns Hopkins Univ, Sch Med, Dept Med, 600 N Wolfe St,Osler 508, Baltimore, MD 21287 USA
NIH, Crit Care Med Dept, Bldg 10, Bethesda, MD 20892 USA
Geiger, G:
Univ Missouri, Sch Med, Columbia, MO USA
:
Univ Hosp Germans Trias, Infect Dis & Fight Aids Fdn, Badalona, Spain
Montgomery, MW:
Brigham & Womens Hosp, Dept Infect Dis, 75 Francis St, Boston, MA 02115 USA
West, NE:
Johns Hopkins Univ, Sch Med, Dept Med, 600 N Wolfe St,Osler 508, Baltimore, MD 21287 USA
Chida, NM:
Johns Hopkins Univ, Sch Med, Dept Med, 600 N Wolfe St,Osler 508, Baltimore, MD 21287 USA
Antar, AAR:
Johns Hopkins Univ, Sch Med, Dept Med, 600 N Wolfe St,Osler 508, Baltimore, MD 21287 USA
Dandachi, D:
Univ Missouri, Dept Med, Columbia, MO USA
Weld, ED:
Johns Hopkins Univ, Sch Med, Dept Med, 600 N Wolfe St,Osler 508, Baltimore, MD 21287 USA
gold, Green Published
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