Clinical course, management and outcomes of COVID-19 in HIV-infected renal transplant recipients: A case series
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,...
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South African Medical Association
2024-04-01
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| Series: | South African Medical Journal |
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| Online Access: | https://samajournals.co.za/index.php/samj/article/view/1374 |
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| author | L Bertels K Manning A Redd T du Toit Z Barday E Muller |
| author_facet | L Bertels K Manning A Redd T du Toit Z Barday E Muller |
| author_sort | L Bertels |
| collection | DOAJ |
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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.
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| format | Article |
| id | doaj-art-1f5bf5a4795c48589114292eae2fc128 |
| institution | Kabale University |
| issn | 0256-9574 2078-5135 |
| language | English |
| publishDate | 2024-04-01 |
| publisher | South African Medical Association |
| record_format | Article |
| series | South African Medical Journal |
| spelling | doaj-art-1f5bf5a4795c48589114292eae2fc1282025-02-10T12:26:10ZengSouth African Medical AssociationSouth African Medical Journal0256-95742078-51352024-04-011143b10.7196/SAMJ.2024.v114i3b.1374Clinical course, management and outcomes of COVID-19 in HIV-infected renal transplant recipients: A case seriesL Bertels0K Manning1A Redd2T du Toit3Z Barday4E Muller5Department of Surgery, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South AfricaDepartment of Surgery, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md., USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md., USA; Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South AfricaDepartment of Surgery, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South AfricaDepartment of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South AfricaDepartment of Surgery, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa;Dean of Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa 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. https://samajournals.co.za/index.php/samj/article/view/1374COVID-19HIVTransplant |
| spellingShingle | L Bertels K Manning A Redd T du Toit Z Barday E Muller Clinical course, management and outcomes of COVID-19 in HIV-infected renal transplant recipients: A case series South African Medical Journal COVID-19 HIV Transplant |
| title | Clinical course, management and outcomes of COVID-19 in HIV-infected renal transplant recipients: A case series |
| title_full | Clinical course, management and outcomes of COVID-19 in HIV-infected renal transplant recipients: A case series |
| title_fullStr | Clinical course, management and outcomes of COVID-19 in HIV-infected renal transplant recipients: A case series |
| title_full_unstemmed | Clinical course, management and outcomes of COVID-19 in HIV-infected renal transplant recipients: A case series |
| title_short | Clinical course, management and outcomes of COVID-19 in HIV-infected renal transplant recipients: A case series |
| title_sort | clinical course management and outcomes of covid 19 in hiv infected renal transplant recipients a case series |
| topic | COVID-19 HIV Transplant |
| url | https://samajournals.co.za/index.php/samj/article/view/1374 |
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