Hydroxychloroquine doesn’t prevent COVID-19, study finds
Prophylactic hydroxychloroquine treatment was not associated with any risk difference for COVID-19 infection, according to an International Journal of Infectious Diseases study yesterday.
The researchers followed a cohort of all 5,488 Danish people who used hydroxychloroquine in both 2019 (for non–COVID-19 reasons) and 2020 and matched them with 54,846 non-users by age and sex. The primary outcome was a COVID-19 diagnosis from Feb 27 to Nov 27, 2020.
Infection rates were comparable between the two groups, with 3.4% of the hydroxychloroquine group and 3.7% of the control group receiving positive diagnoses. Final modeling adjusted for comorbidities and pharmaceutical treatments and resulted in a hazard ratio of 0.90 (95% confidence interval, 0.76 to 1.07).
“Our study, which is the largest to investigate the primary prophylactic effect of hydroxychloroquine against SARS-CoV-2, does not support any prophylactic benefit of hydroxychloroquine in the prevention of infection with SARS-CoV-2,” write the researchers.
Currently, the World Health Organization does not recommend using hydroxychloroquine to prevent or treat COVID-19 infections.
Jun 1 Int J Infect Dis study
COVID-19 hospitalization, ICU admission higher in HIV patients
Adult COVID-19 patients diagnosed as having HIV had higher rates of hospital and intensive care unit (ICU) admission than those without HIV, according to an Open Forum Infectious Diseases study yesterday. Thirty-day mortality, however, was similar between the two groups.
The researchers looked at 297,194 COVID-19 infections confirmed in US adults in 2020, of which 0.6% were in people who also had HIV. Those with HIV had higher COVID-19 hospitalization rates (16.5% vs 7.6%; odds ratio [OR], 1.26), ICU admission (4.2% vs 2.3%), and mechanical ventilation (2.4% vs 1.6%), but 30-day mortality was comparable, at 2.9% in the HIV group and 2.3% in the non-HIV group.
Severe COVID-19 disease in HIV patients was associated with older age (adjusted OR [aOR], 8.33) and CD4 levels of less than 200 cells per cubic millimeter (aOR, 8.33), although the researchers note that only 14.0% of people with HIV reported CD4 count. CD4, or cluster of differentiation 4, is a glycoprotein on the surface of immune cells.
Overall, HIV patients had more COVID-19 symptoms and elevated procalcitonin and interleukin-6, both markers of inflammation.
COVID-19 patients with HIV were more commonly younger than those without HIV (average, 43.3 vs 46.5 years), male (69.4% vs 44.3%), Black or Hispanic (49.1% vs 19.7%, 18.1% vs 15.2%), and less healthy, with comorbidities such as cardiovascular disease (46.8% vs 26.1%), obesity (24.7% vs 14.8%), and diabetes (21.9% vs 12.8%). They were also more likely to have a history of smoking, alcohol, and drug use.
“We hypothesize that the reasons for these findings may be related to the combined effects of the high prevalence of underlying comorbidities coupled with the possibility of a more vigorous manifestation of the cytokine release syndrome in [people with HIV],” the researchers write, adding that the higher hospitalization risk persisted after propensity score matching.
Jun 1 Open Forum Infect Dis study
Few randomized, controlled COVID drug trials echo observational results
Most non-randomized study results looking at potential COVID-19 drugs were not able to be replicated in randomized, controlled trials (RCTs), according to a Journal of Antimicrobial Chemotherapy article today.
The researchers looked at 133 trial arms in 117 studies published from Jan 1 to Oct 27, 2020. The most commonly examined drug was hydroxychloroquine on its own or with other drugs such as azithromycin (49 arms total), and other frequent interventions were interleukin-6 inhibitors (36) and corticosteroids (26).
Most intervention arms were in non-randomized cohorts (78.2%, 104). Of these, 30.8% (32) showed significant survival benefits. Comparatively, 6.9% of RCTs (2 of 29) reported significant survival benefit, both for corticosteroids. Overall, the researchers say that 87.5% of non-randomized trials that showed survival benefits did not have replicated results in corresponding RCTs.
“The results of most non-randomized studies reporting survival benefit of potential anti–COVID-19 drugs were not replicated by large RCTs,” they conclude. “Regulators and healthcare professionals should exercise caution and resist the pressure to approve and prescribe drugs of unproven efficacy and potential toxicity to optimize patient care and maintain public trust in medical science.”
Data showed that RCTs had a larger median patient sample (243 vs 191 participants) and were more likely to be multicentered (69.0% vs 39.4%) and published in journals with a higher impact factor, a measure of how many citations a journal has received in the past 2 years (median score, 45.5 vs 4.3). RCTs were also less likely to have survival as a primary outcome (10.3% vs 38.5%).
Jun 2 J Antimicrob Chemother study