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Abstract: PO0677

AKI in People Living with HIV Hospitalized with COVID-19

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Fisher, Molly, Montefiore Medical Center, Bronx, New York, United States
  • Fazzari, Melissa, Yeshiva University Albert Einstein College of Medicine, Bronx, New York, United States
  • Hanna, David B., Yeshiva University Albert Einstein College of Medicine, Bronx, New York, United States
  • Patel, Viraj V., Montefiore Medical Center, Bronx, New York, United States
  • Felsen, Uriel R., Montefiore Medical Center, Bronx, New York, United States
  • Ginsberg, Mindy, Yeshiva University Albert Einstein College of Medicine, Bronx, New York, United States
  • Anastos, Kathryn, Montefiore Medical Center, Bronx, New York, United States
  • Ross, Michael J., Yeshiva University Albert Einstein College of Medicine, Bronx, New York, United States
Background

People living with HIV (PLWH) have an increased burden of kidney disease and unique factors that may place them at increased risk for acute kidney injury (AKI) in the setting of COVID-19. The aim of our study was to characterize the incidence, risk factors and outcomes of AKI among hospitalized PLWH with COVID-19.

Methods

We performed a retrospective study of adult PLWH hospitalized with laboratory-confirmed COVID-19 in a large healthcare system in Bronx, New York from March 10-May 11, 2020. Data collected included demographics, comorbidities, antiretroviral therapy (ART), initial laboratory data, and preadmission CD4 count and HIV viral load. AKI was defined and staged using KDIGO criteria. Fisher and Wilcoxon tests compared differences in those with and without AKI.

Results

During the study period, 77 PLWH were hospitalized with COVID-19. The majority were Black or Hispanic, 50% were men, 53% had hypertension, 31% diabetes mellitus, 22% chronic kidney disease (CKD) and 14% end-stage kidney disease (ESKD). Mean CD4 count was 470 cells/uL and 83% had a suppressed HIV viral load (<40 copies/mL). After excluding 11 with ESKD, AKI incidence was 50%. Those with AKI were older [63 (SD 9) vs 55 (SD 13) years, p=0.005], more were black (56% vs 37%, p=0.01) and more had CKD (42% vs 9%, p<0.0001) compared to those without AKI. There were no significant differences in CD4 count, HIV viral load, or use of tenofovir-containing ART between those with and without AKI. By AKI severity, 11/33 (33%) were stage 1, 4/33 (12%) stage 2 and 18/33 (55%) stage 3. Mechanical ventilation (33% vs 0%, p=0.0004) and in-hospital mortality (42% vs 3%, p=0.0002) were more common in those with AKI. Of 6 patients who required renal replacement therapy, 4 died and 2 remained RRT dependent. Admission white blood cell count, neutrophil/lymphocyte ratio, D-dimer, ferritin, C-reactive protein and lactate dehydrogenase levels were significantly higher in those with AKI.

Conclusion

The incidence of AKI in PLWH hospitalized with COVID-19 was high and associated with poor outcomes. We did not identify HIV-specific risk factors for AKI in the setting of COVID-19. Admission inflammatory markers may be predictive of AKI in PLWH with COVID-19.