CD4 count below 500 is always an issue. One of these stupid magazines wrote 15 years ago that a CD4 count below 500 was "the beginning of the end". Well, I've seen people with CD4 counts below ten who, today, are active and productive members of this society in which 1/3 of the so-called “normal” people would refuse to work alongside “a person like that”.
Just like the Devils? And there are fools who say: Social death does not exist.
A CD4 count below 500 or a detectable viral load increases the risk of severe COVID-19.
I have seen the headline of an article, which I have not read so as not to get nervous, where the person says that having HIV and COVID is not "something like that", that the danger is the comorbidities.
Well, before I go on with the text, I need to establish an aspect of this, something that has bothered me more than, in theory, it would be “lawful” to bother me. Because, as I understood, for this individual, HIV infection, or AIDS, are not “morbidities”.
Maybe he's right, but to convince me of that, he'll have to explain to me what killed nearly forty million people in nearly forty years, given that, according to him. HIV/AIDS is by no means morbid.
Guys, I could list the tombs I knelt before and cried for losing, not to death, but to these “non-morbidities” over years of lead, in my life, to later see the cynicism of a person apologizing for not being aware of so much suffering. On the unfortunate day I saw that video I broke a monitor screen by punching the screen exactly where I saw that person telling me that and, plus ultra, being applauded.
See, I'm not a very complicated person. Just use your brain, think and understand me. See the heresy I will say here. The word “aidetic” doesn't bother me. Do you know why? For no word can have a greater weight than that which is attributed to it.
Do you call me AIDS?
Great, because I am the AIDS patient who has maintained, almost without help, this "blog" for twenty-one years which is, in some cases, more than the entire life of many people who, right now, read me and hate (pick a number).
Going further, a journalist, a great friend of mine, Laete Braga, who has already left this world, Laerte Braga, defined society from 2011 to 2020 as the society of spectacle. Just think of “stick-de-selfie”. I didn't disagree with him, but I answered him like this:
— 'Friend, it is also the society of euphemism'! This mania for looking for “less unpleasant” words to say the same things, or even denying that certain things are problems, tends to lead to exactly these problems. Some examples:
Sexually Transmitted Diseases i Euphemically Transmitted Infections
I posted something on Instagram and talked about “Sexually Transmitted Diseases”. I got a “wow, it's STI, sexually transmitted infections” which is now said. It was, shall we say, a high ball that I had been waiting for a long time and I bounced back. Come on
Boring (pediculosis pubis) is an Infection? It's an infestation and parasitosis. Well, if you take a short trip, two or three hours, from São Paulo, you will surely find the person who has not even heard of sexually transmitted diseases.
For him it is “venereal disease”, linked, yes, to our “good Venus”, goddess of love, in some cultures. The message needs to arrive and, please, it can't, in any way, arrive encrypted or academized. Everymonth excludes; and generally excludes those who most need the clear and clarifying message.
If you talk about genital warts, or HPV, chances are the person will come in without knowing and leave without understanding. I myself, when I was 15 years old (I started early and very badly), had such an HPV crisis and, when I asked a friend's father for an explanation, he said:
— 'This is a bad disease'! You have to go to the doctor. —— “Bad Disease”.
This introduction, quite unlucky, is justified because of this thing of comorbidities and COVID.
HIV/AIDS, in a way, depending on the CD4 cell count, or the viral load, depending on whether or not the person is, associated with a COVID-19 infection is a life-threatening situation. Not! The risk is death. And that's exactly why, more than two in the morning, upon finding the text below, I decided, despite the atrocity of the pain that polyneuropathy causes me, to translate and publish, because the message, my readers, friends and those others, sweetened, needs to arrive. And it needs to come clear and fast.
Mostly all this, I want to reiterate one thing:
Yes, there is life with HIV. But that's not normal. Having HIV, or AIDS, means being sick, or you wouldn't need to take antiretrovirals. I take them, despite being imprisoned in a body that, for some time now, decided to torture me, because I love Mara, I love my life, I love this world and, I believe, I can still do something for it.
And here I am, my hands and feet in tatters, unable to find a single square inch of my body that doesn't hurt. But if that's what God wants it to be, so be it. Even because, in my youth, I shamelessly abused the fragility of many female hearts.
Sic Transit Gloria Mundum
A US study found that people with HIV who had CD4 counts below 500, or detectable viral load, had a much higher risk of hospitalization with COVID-19 compared to people with higher CD4 counts or suppressed viral load.
The large study, conducted by researchers at the Bloomberg School of Public Health at Johns Hopkins University, updates findings presented at the March 2021 Conference on Retroviruses and Opportunistic Infections. It collected data on a larger group of people with HIV than the previous analysis over a longer period and analyzed the risk of serious COVID-19 outcomes by HIV viral load and CD4 count.
The results were made available as a prepress and have not yet been peer reviewed.
The study population consisted of 1.446.913 adults with a laboratory-confirmed diagnosis of SARS-CoV-2 between January 1, 2020 and May 21, 2021 at US hospitals participating in the National COVID Cohort Collaborative Consortium. Most participating sites are major academic medical centers.
Of this population, 8.270 were living with HIV, 11.392 had undergone solid organ transplantation, and 267 were people with HIV who had undergone solid organ transplantation.
People living with HIV diagnosed with COVID-19 had a median age of 50 years, 72,5% were male, 43% were white, of which 8% were Hispanic, 33% were black and 23% were of other ethnicities . Eleven percent had three or more comorbidities and 12% had two comorbidities.
CD4 count data for the previous year were available for 3.574 people with HIV (43%). Of these, 61% had a CD4 count above 500, 16% between 350 and 500, and 22% below 350. Previous year viral load data were available for 1.407 (17%). Of these, two-thirds (67,5%) had a viral load below 50 copies / ml, 20% between 50 and 1.000 copies / ml and 11% above 1.000 copies / ml.
Women, as always, the system's biggest victim
People who underwent solid organ transplants were older (mean age 57 years), less likely to be men (40% were women), more frequently were non-Hispanic whites (48%), and had a higher burden of comorbidities ( 44% had three or more, 21% had two) compared with people without HIV or a history of transplantation (p < 0,01).
People without HIV or a history of transplantation with COVID-19 were slightly more likely to be women (55%), were younger than other groups (mean age 47 years), more often Non-Hispanic whites (53%), less often Black non-Hispanic (13,5%) and less likely to have multiple comorbidities (4,5% had three or more, 4% had two).
Just over two-thirds (68%) of the study population had mild COVID-19 or asymptomatic infection diagnosed by PCR testing. An amount of more than three percent (3,4%) was assessed in an emergency department, but not admitted to the hospital, 26% of the study population was admitted to the hospital. without the need for mechanical ventilation, 0,9% were hospitalized, required mechanical ventilation and survived, and 1,7% died of COVID-19. It may seem small, but it wasn't you, or someone you love, who lost their life.
Vulnerability and Fragility of Seropositives
People with HIV were significantly more likely to visit an emergency department to be evaluated for symptoms of COVID-19 (odds ratio 1,28, 95% CI 1,27-1,29), than to be hospitalized for ventilation ( OR 1,43, 95% CI 1,43-1,43) and dying of COVID-19 (OR 1,20, 95% CI 1,19-1,20), but they were less likely than people without immunosuppressive disorders to be admitted to the hospital without the need for ventilation (OR 0,81, 95% CI 0,78-0,86). These differences remained significant after adjusting for sociodemographic factors and burden of comorbidities.
The risks of serious outcomes were greatest for people who underwent solid organ transplants. People who underwent solid organ transplants were twice as likely to be admitted to the hospital without the need for ventilation (OR 2,00, 95% CI 1,93-2,08), five times more likely to be hospitalized and need of mechanical ventilation (OR 4,82, 95% CI 4,78-4,86) and almost three and a half times more likely to die from COVID-19 (OR 3,38, 95% CI 3,35-3,41 ) compared to people without immunosuppressive disorders.
Mechanical Ventilation Need: 400% Greater
The risk of severe COVID-19 requiring mechanical ventilation was four times greater in people with HIV who underwent solid organ transplants (aOR 4,02, 95% CI 4,02-4,02) compared to those with the disorders immunosuppressive drugs, but the small sample size for this patient group means that risk estimates can be inaccurate.
In people living with HIV, the risk of serious outcomes was greatest in those with CD4 counts below 500 and in people with detectable viral loads. After adjusting for sociodemographic factors, smoking, and comorbidities, people with HIV with CD4 counts between 350 and 500 were nearly three times more likely to be admitted to hospital than people with CD4 counts above 500 (odds 'adjusted ratio 2,9, 95, 1,5% CI 5,6-4). People with CD350 counts below 3.2 were six times more likely to be admitted to hospital (aOR 11.1-4) compared to people with CD500 counts above XNUMX.
Viral Suppression is Absolute Necessity
Comparing the results according to viral suppression status in people with a CD4 count above 500, the study found that even with a high CD4 count, people with a viral load above 50 copies/ml were three times more likely to being admitted to hospital compared to people with a viral load below 50 copies/ml after adjustment for sociodemographic factors and comorbidities (aOR 3.1, 95% CI 1,6-6,2).
These findings from a large sample of people living with HIV in the United States add weight to the findings of a large international study conducted by the World Health Organization, presented last month at the International AIDS Society's Conference on the Science of HIV.
Higher Risks of Serious Outcomes (euphemism?)
That study found that people with HIV were at increased risk for severe COVID-19 outcomes, but the study did not include data on the impact of CD4 count or viral load at risk. The WHO study also failed to find a significant association between HIV and an increased risk of death due to COVID-19 results outside the WHO African region, unlike this US study.
Spanish researchers also identified an increased risk of severe COVID-19 outcomes in people with CD4 counts below 500 in research also presented at IAS 2021 last month.
"Our results call for a urgent action to administer the SARS-CoV-2 vaccine for PLWHA in the United States and in the global population, especially targeting those individuals with poorly controlled HIV infection and those living in geographic regions where vaccine uptake by the general public was lower,” the study authors in the United States conclude.
They say that people with HIV who are especially vulnerable to COVID-19 may need special efforts to re-engage them in HIV care and ensure vaccination.
Substance use, poor mental health and unstable housing can affect the ability of people with HIV to be involved in HIV care, the authors say, and programs designed to involve people in HIV care can be essential to ensure that people who may be especially vulnerable to the poor COVID-19 outcomes are involved in HIV treatment and COVID-19 vaccinated.
Translated by Cláudio Souza, on August 14, 2000, from the original written by Keith Alcorn em August 11, 2021, published in Aidsmap at this link: CD4 count below 500 or detectable viral load raise the risk of severe COVID-19 for people with HIV
Sun J et al. Severity of disease COVID-19 among people with HIV infection or solid organ transplantation in the United States: a nationally representative, multicenter observational cohort study. Med Rxiv https://doi.org/10.1101/2021.07.26.21261028