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Case Reports
. 2022 Feb 11;19(1):6.
doi: 10.1186/s12981-022-00430-x.

Clinical outcomes after IL-6 blockade in patients with COVID-19 and HIV: a case series

Samuel J Minkove #  1   2 , Grant Geiger  3 , Josep M Llibre  4 , Mary W Montgomery  5 , Natalie E West  1 , Natasha M Chida  1 , Annukka A R Antar #  1 , Dima Dandachi #  6 , Ethel D Weld #  7 ; HIV-COVID-19 Consortium
Collaborators, Affiliations
Case Reports

Clinical outcomes after IL-6 blockade in patients with COVID-19 and HIV: a case series

Samuel J Minkove et al. AIDS Res Ther. .

Abstract

Background: In hospitalized people with HIV (PWH) there is an increased risk of mortality from COVID-19 among hospitalized PWH as compared to HIV-negative individuals. Evidence suggests that tocilizumab-a humanized monoclonal interleukin (IL)-6 receptor inhibitor (IL-6ri) antibody-has a modest mortality benefit when combined with corticosteroids in select hospitalized COVID-19 patients who are severely ill. Data on clinical outcomes after tocilizumab use in PWH with severe COVID-19 are lacking.

Case presentation: We present a multinational case series of 18 PWH with COVID-19 who were treated with IL-6ri's during the period from April to June 2020. Four patients received tocilizumab, six sarilumab, and eight received an undocumented IL-6ri. Of the 18 patients in the series, 4 (22%) had CD4 counts < 200 cells/mm3; 14 (82%) had a suppressed HIV viral load. Eight patients (44%), all admitted to ICU, were treated for secondary infection; 5 had a confirmed organism. Of the four patients with CD4 counts < 200 cells/mm3, three were treated for secondary infection, with 2 confirmed organisms. Overall outcomes were poor-12 patients (67%) were admitted to the ICU, 11 (61%) required mechanical ventilation, and 7 (39%) died.

Conclusions: In this case series of hospitalized PWH with COVID-19 and given IL-6ri prior to the common use of corticosteroids, there are reports of secondary or co-infection in severely ill patients. Comprehensive studies in PWH, particularly with CD4 counts < 200 cells, are warranted to assess infectious and other outcomes after IL-6ri use, particularly in the context of co-administered corticosteroids.

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Conflict of interest statement

The authors have no competing interests to disclose.

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