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OBJECTIVE: To determine the association between race/ethnicity and COVID-19 outcomes in individuals with systemic lupus erythematosus (SLE). METHODS: Individuals with SLE from the US with data entered into the COVID-19 Global Rheumatology Alliance registry between March 24, 2020 and August 27, 2021 were included. Variables included age, sex, race, and ethnicity (White, Black, Hispanic, other), comorbidities, disease activity, pandemic time period, glucocorticoid dose, antimalarials, and immunosuppressive drug use. The ordinal outcome categories were: not hospitalized, hospitalized with no oxygenation, hospitalized with any ventilation or oxygenation, and death. We constructed ordinal logistic regression models evaluating the relationship between race/ethnicity and COVID-19 severity, adjusting for possible confounders. RESULTS: We included 523 patients; 473 (90.4%) were female and the mean ± SD age was 46.6 ± 14.0 years. A total of 358 patients (74.6%) were not hospitalized; 40 patients (8.3%) were hospitalized without oxygen, 64 patients (13.3%) were hospitalized with any oxygenation, and 18 (3.8%) died. In a multivariable model, Black (odds ratio [OR] 2.73 [95% confidence interval (95% CI) 1.36-5.53]) and Hispanic (OR 2.76 [95% CI 1.34-5.69]) individuals had higher odds of more severe outcomes than White individuals. CONCLUSION: Black and Hispanic individuals with SLE experienced more severe COVID-19 outcomes, which is consistent with findings in the US general population. These results likely reflect socioeconomic and health disparities and suggest that more aggressive efforts are needed to prevent and treat infection in this population.

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Chronic hepatitis C virus (HCV) infection is the leading cause of chronic liver disease. While in the general population the prevalence ranges between 1-2%, 6-8% of patients with psychiatric disorders and 60-90% of intravenous drug users (IDU) are chronically infected with the HCV. In recent years, the combination treatment with pegylated interferon-alpha (IFNalpha) and ribavirin led to significantly increased sustained response rates. Nevertheless, IFN-alpha treatment is still contraindicated in patients with mental illness or intravenous drug abuse because of a postulated increased risk to develop severe psychiatric side effects such as depression, suicidal thoughts, irritability and relapse in drug or alcohol abuse. However, recent data do not support this view. In an own prospective and controlled trial, patients with psychiatric disorders or methadone substitution were not more likely to develop depression or to discontinue treatment early compared to HCV-infected controls without a mental illness. Patients were treated by hepatologists and psychiatrists together and received antidepressants in case of depressive mood changes. These data are supported by other recently published trials. HCV-infected patients with psychiatric disorders or drug addiction should not be longer excluded from an otherwise effective antiviral treatment with pegylated IFN-alpha and ribavirin.

La infección crónica por el virus de la hepatitis C (HVC) es la primera causa de enfermedad crónica del hígado. Mientras que en la población general la prevalencia se encuentra entre el 1% y el 2%, 6% a 8% de los pacientes con trastornos psiquiátricos y 60% a 90% de los adictos a drogas intravenosas están crónicamente infectados por el HVC. En los últimos años, el tratamiento combinado con peginterferón alfa (IFN-alfa) y ribavirina llevó a un aumento significativo y sostenido de las tasas de respuesta. Sin embargo, el tratamiento con IFN-alfa está aún contraindicado en pacientes con enfermedades mentales o con antecedentes de abuso de drogas intravenosas por el riesgo aumentado de sufrir graves efectos adversos psiquiátricos como depresión, ideas suicidas, irritabilidad y recaídas en el abuso de drogas o alcohol. No obstante, existen datos recientes que no apoyan esta idea. En un estudio propio, prospectivo y controlado los pacientes con trastornos psiquiátricos o en tratamiento de sustitución con metadona no fueron más propensos a desarrollar depresión, o a discontinuar el tratamiento en comparación con controles infectados con HVC y sin enfermedad mental. Los pacientes fueron tratados en conjunto por hepatólogos y psiquiatras y recibieron antidepresivos en caso de cambios depresivos del estado de ánimo. Estos datos son respaldados por otros estudios recientemente publicados. Los pacientes infectados por el HVC que presentan trastornos psiquiátricos o adicción a las drogas ya no deberían ser excluidos del tratamiento efectivo con peg-IFN-alfa y ribavirina.

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