Characteristics and Outcomes of COVID-19 in Patients With HIV

A Multicentre Research Network Study

Yousaf B. Hadi; Syeda F.Z. Naqvi; Justin T. Kupec; Arif R. Sarwari

Disclosures

AIDS. 2020;34(13):F3-F8. 

In This Article

Abstract and Introduction

Abstract

Objective: We studied clinical outcomes of COVID-19 infection in patients living with HIV (PLH) in comparison to non-HIV population.

Design: Analysis of a multicentre research network TriNETX was performed including patients more than 10 years of age diagnosed with COVID-19.

Methods: Outcomes in COVID-19 positive patients with concurrent HIV (PLH) were compared with a propensity-matched cohort of patients without HIV (non-PLH).

Results: Fifty thousand one hundred and sixty-seven patients with COVID-19 were identified (49,763 non-PLH, 404 PLH). PLH were more likely to be men, African–American, obese and have concurrent hypertension, diabetes, chronic kidney disease and nicotine dependence compared with non-PLH cohort (all P values <0.05). We performed 1 : 1 matching for BMI, diabetes, hypertension, chronic lung diseases, chronic kidney disease, race, history of nicotine dependence and sex. In unmatched analysis, PLH had higher mortality at 30 days [risk ratio 1.55, 95% confidence interval (95% CI): 1.01–2.39] and were more likely to need inpatient services (risk ratio 1.83, 95% CI: 1.496–2.24). After propensity score matching, no difference in mortality was noted (risk ratio 1.33, 95% CI: 0.69–2.57). A higher proportion of PLH group needed inpatient services (19.31 vs. 11.39%, risk ratio 1.696, 95% CI: 1.21–2.38). Mean C-reactive protein, ferritin, erythrocyte sedimentation rate and lactate dehydrogenase levels after COVID-19 diagnosis were not statistically different and mortality was not different for PLH with a history of antiretroviral treatment.

Conclusion: Crude COVID-19 mortality is higher in PLH; however, propensity-matched analyses revealed no difference in outcomes, showing that higher mortality is driven by higher burden of comorbidities. Early diagnosis and intensive surveillance are needed to prevent a 'Syndemic' of diseases in this vulnerable cohort.

Introduction

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) related disease (COVID-19) has emerged as the major health crisis of 2020.[1] Its impact on patients with preexisting infection with HIV has hitherto not been studied extensively. Recently, the Centers for Disease Control and Prevention (CDC) highlighted that patients living with HIV may be at a heightened risk of severe illness from SARS-CoV-2 as compared to the general population.[2] This postulated increased risk was attributed to both biological immune compromise and comorbidities as well as socially produced burdens. However, others have suggested that the use of antivirals in this population may confer relative protection from the virus.[3]

Considering the large global burden of patients living with HIV, data on COVID-19 infection in these patients are scarce and are limited to case reports and small case series, which do not allow for comparison of outcomes with non-HIV populations.[4,5] We aimed to utilize a multicentre research network to study outcomes in patients with COVID-19 with preexisting HIV infection in comparison to those without HIV coinfection.

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