HIV Tied to Poorer COVID-19 Outcomes in New York State

By Marilynn Larkin

February 10, 2021

NEW YORK (Reuters Health) - Adult New Yorkers living with HIV had poorer COVID-19-related outcomes in a retrospective study.

"New York State has long been a focal point of both the U.S. HIV and COVID-19 epidemics (and) it has been hypothesized that persons living with HIV may be at elevated risk for SARS-CoV-2 infection and/or more severe COVID-19 outcomes," Dr. Eli Rosenberg of the University of Albany School of Public Health in New York told Reuters Health by email.

"Further, because HIV infection is also associated with comorbidities and social conditions linked to more severe COVID-19 outcomes, this may also drive (the) elevated COVID-19 risks," he said. "We had an opportunity to do a large-scale study to understand the unique intersection of these conditions."

"We found that, as a group, persons with an HIV diagnosis were more likely to be diagnosed, hospitalized, and die in the hospital with COVID-19, compared to other New Yorkers," he said. "HIV infection was associated with more severe COVID-19 disease in New York, and those with more advanced HIV disease were more likely to experience severe COVID-19."

As reported in JAMA Network Open, the team matched data from HIV surveillance, COVID-19 diagnoses and hospitalization databases in New York State between March 1-June 15, 2020. Among more than 108,000 people living with HIV, COVID-19 was diagnosed in 2,988 individuals (70.6% men; mean age, 54; 80.6% living in New York City), including 896 (30%) who were hospitalized and 207 (7%) who died in the hospital.

After standardization, individuals with and without HIV had similar COVID-19 diagnosis rates (standardized rate ratio, 0.94). However, those with HIV were hospitalized more, per population (sRR, 1.38) and among those diagnosed (sRR, 1.47).

Similarly, higher mortality was seen with HIV per population (sRR, 1.23) and among those diagnosed with COVID-19 (sRR, 1.30), but not among those hospitalized (sRR, 0.96).

"We documented a gradient of increased hospitalization need across more advanced stages of CD4-defined HIV disease stage," Dr. Rosenberg noted. Specifically, hospitalization risk increased with disease progression to HIV stage 2 (aRR, 1.29) and stage 3 (aRR, 1.69), relative to stage 1.

Non-Hispanic Blacks (aRR, 1.59) and Hispanics (aRR, 2.08) with HIV were more likely to receive a diagnosis of COVID-19 than whites but not more likely to be hospitalized or to die when hospitalized.

Dr. Rosenberg said, "Recent findings from Europe and South Africa have reported similar linkages between HIV infection and poor COVID-19 outcomes. Although the direct role of HIV infection itself in causing severe COVID-19, compared to other comorbidities associated with HIV, remains to be elucidated, this population should be considered by clinicians as a priority group for COVID-19 prevention and treatment."

"With HIV infection as an apparent underlying illness of concern for COVID-19, persons with diagnosed HIV should be considered as a population of importance for vaccination, given available supply," he concluded.

Dr. Manish Sagar, an infectious disease physician at Boston Medical Center, commented in an email to Reuters Health, "We have not done a similar detailed analysis although, in general, I would say we have not found a similar trend."

"We have not observed that HIV patients are more likely to have poor outcomes after (SARS-CoV-2) infection," he said. "HIV-infected patients that are not on antiretroviral medications are likely to have a poor outcome."

"My suspicion is that the social determinants that portend poorly for SARS-CoV-2 infection and COVID-19 outcomes are more prevalent in the HIV-positive as compared to HIV-negative population," he said. "In Massachusetts, vaccines are being prioritized for people at greater risk for COVID, such as those with greater socio-economic risk factors."

"I do not think HIV as a diagnosis itself should be used to recategorize people with regard to vaccination," Dr. Sagar concluded.

SOURCE: JAMA Network Open, online February 3, 2021