IL-6 TREATMENT FOR HIV PATIENTS SARS-COV-2 INFECTED

It has been observed that severe COVID-19 in the general population is associated with a hyperinflammatory syndrome similar to cytokine release syndrome (CRS). The connection between COVID-19 and HIV is not completely understood, however, it has been made a study by WHO where they find that HIV was independently associated with a higher risk of in-hospital COVID-19 mortality even after adjusting for age, sex, disease severity admission and the number of underlying conditions.

In a recent study that was made at the PWH, it was observed that Tocilizumab which is a humanized monoclonal interleukin (IL-6) has a modest mortality benefit when combined with Corticosteroids in select hospitalized COVID-19 patients who are severely ill.

This study presented 4 narrative case reports accompanied by a description of the outcomes of 18 patients diagnosed with HIV and PCR confirmed COVID-19 treated with IL-6 between April and June 2020.

Minkove et al. used data from patients aged between 29 - 76 years old, where 13 patients were Black or Hispanic. In all of these cases, at least one comorbidity has been present HTN, DM, CKD were most commonly reported. All patients were on antiretroviral therapy before being admitted and they were confirmed with SARS-CoV-2 infection by PCR. IL-6 was administered as follows: Tocilizumab to 4 patients, Sarilumab to 6 and an unknown interleukin to 8. Of 18 patients only 2 received Corticosteroids and none received Remdesivir, due to the local standard of care in that period time early in the pandemic. 77% of the patients in the series had at least one co-morbid condition. In 8 patients was identified specific organism infections including Stenotrophomonas spp, S. aureus, C. albicans, E. cloacae, K. aerogenes respiratory infections, and disseminated VZV (Varicella-Zoster Virus).

The first case was about a patient of 57 years with unknown medical conditions who presented to the ED with fever, dyspnea and fatigue. He was tested positive for SARS COV2 by PCR, Ceftriaxone and Azithromycin were initiated. On the 4th day, hypoxemia progressed requiring intubation and he received Tocilizumab 480 mg, but not Corticosteroids or Remdesivir. On 40th day of hospitalization, he was diagnosed with AIDS and presumed late latent Syphilis. After 47 days he was positive for VZV. He died on the 49th day and an autopsy was declined.

The second case was about a 74 years old patient with HIV, dementia, hypertension, stage 3 chronic kidney diseases and presumed gastric carcinoma treated with one dose of Pembrolizumab. He showed up to the ED with abdominal pain, fatigue and altered mental status. He was tested positive for SARS-CoV-2 infection by PCR. Remdesivir and Corticosteroids weren't administered. On the 9th day of hospitalization, he received 400 mg of Tocilizumab. He died of multisystem organ failure on the 21st day.

The third case was about a 60 years old woman with HIV, recently cured hepatitis C virus, cirrhosis and Stage 1 CKD. She showed up to the ED with cough, headache, dyspnea, fever, sore throat, myalgias, and fatigue. She was tested positive for SARS COV2. She received Corticosteroids, but not Remdesivir. On the second day, she received 400 mg of Tocilizumab and initiated 4 days of Methylprednisolone and Hydroxychloroquine. On the 27th day, she was discharged.

The fourth case was about a 39 years old man with HIV, HNT presented with cough, dyspnea, fever, sore throat, myalgias and fatigue. He had tested positive for SARS-CoV-2 by PCR. Hypoxia worsened and he received 400 mg of Tocilizumab and initiated 4 days of Methylprednisolone. His clinical condition improved and he was discharged on the 9th day.

Clinical outcomes in the overall cohort and particularly among treated patients for secondary infection were poor, with death occurring in half of treated patients for infection. Immune-based therapy for COVID-19, while potentially lifesaving, may also be potentially harmful in certain immunocompromised patients.

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* Minkove SJ, Geiger G, Llibre MJ, Montgomery MW, West NE, Chida MN, et al. Clinical outcomes after IL-6 blockade in patients with COVID-19 and HIV: a case series. AIDS Res Ther. 2022;19(1):6