Incidence of SARS-CoV-2 infection and clinical characteristics in children and young people living with HIV in Europe

23 Aug, 2022

Background: HIV has been shown to be independently associated with increased COVID-19 mortality in adults, but data in children and young people living with HIV (CYPLHIV) are limited. We assessed the incidence of SARS-CoV-2 infection in CYPLHIV in Europe and describe clinical characteristics and outcomes.

Methods: CYPLHIV in follow-up in participating EPPICC cohorts in Europe on or after 01-Jan-20 were included, including data through adult care where available. Participants were at risk from 01-Jan-20 until last visit, age 25 years or first SARS-CoV-2 infection (defined as positive PCR test or hospitalised with presumed COVID19 diagnosis). Data cut-off varied by cohort (range: 13-Mar-20 to 21-Feb-22). Additional clinical data were collected using adapted ISARIC/WHO standardised report forms. COVID-19 severity was classified based on WHO criteria.

Results: 1686 eligible CYPLHIV from 11 cohorts across 9 European countries were included, of whom 128 (8%) met our definition of SARSCoV-2 infection. Incidence was 49 (95% confidence interval 41-58) per 1,000 personyears. CYPLHIV with SARS-CoV-2 were older than those without SARS-CoV-2 (median age at start of 2020 15.7 (IQR 11.5-18.8) vs. 13.6 (8.8-17.5) years, p=0.020), and were less likely to be HIV virally-suppressed <50 copies/mL (45% vs. 57%, p=0.023), but there was no difference in sex, CD4 count, obesity or ethnicity (all p>0.25). Reason for PCR test among those diagnosed was available in 26/128 (20%) cases: 14 (54%) contact tracing, 10 (38%) symptomatic and 2 (8%) routine screening. Clinical data were available for 38/128 (30%) of cases. Among 37 with symptom data available, 22 (59%) experienced ≥1 symptom of COVID19, the most common being: cough (13/37, 35%), fever (9/37, 24%), loss of smell (9/37, 24%). Among symptomatic children, disease severity was classified as mild for all. Among 10 with symptoms and available medication data, 4 (40%) received medication: ibuprofen (n=3), antibiotics (n=2), interferon-alpha (n=1). Two CYPLHIV were hospitalised (range: 3-23 days). One CYPLHIV had ongoing symptoms at 6 months. No deaths were reported.

Conclusions: Incidence of SARS-CoV-2 infection in CYPLHIV was relatively low; among those with symptoms of COVID-19, none experienced severe disease, and there were few hospitalisations and no deaths.

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