COVID-19 Testing, Characteristics, and Outcomes Among People Living With HIV in an Integrated Health System

Jennifer J. Chang, MD; Katia Bruxvoort, PhD; Lie H. Chen, DrPH; Bobak Akhavan, MD; Janelle Rodriguez, MD; Rulin C. Hechter, PhD


J Acquir Immune Defic Syndr. 2021;88(1):1-5. 

In This Article


We conducted a retrospective cohort study among health plan members at Kaiser Permanente Southern California (KPSC) between March 1, 2020, and May 31, 2020.

Study Setting

KPSC has 15 medical centers and 234 medical offices, serving more than 4.6 million members with similar racial/ethnic diversity as the surrounding Southern California population.[19] The comprehensive electronic health record system in KPSC captures all aspects of outpatient care, emergency department visits, and hospitalizations and laboratory tests and pharmacy dispensing records.

Study Population

The underlying study population included all adult (aged 18 years or older) KPSC members by May 31, 2020. HIV status was identified from the KPSC HIV patient registry. PLWH and HIV-uninfected adults aged 18 years or older with at least 1 day of KPSC membership between March 1, 2020, and May 31, 2020, were included in the analysis.

COVID-19 Case Definitions

COVID-19 cases were defined by either (1) a SARS-CoV-2 molecular diagnostic test showing a positive result or (2) a clinical diagnosis with documented ICD-10 codes from health care encounters in outpatient, emergency department, or inpatient settings. COVID-19 hospitalizations were defined as any inpatient admission 14 days before or 30 days after a severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2 test with a positive or clinical diagnosis.

Measures and Chart Review

We compared baseline demographics, comorbidities, and health care utilization among PLWH and HIV-uninfected cohorts. For 57 PLWH with confirmed COVID-19 infection, we also reviewed baseline HIV-specific characteristics and presenting symptoms using the electronic health record, including demographics (age at diagnosis, sex, and race/ethnicity), insurance type, most recent body mass index (BMI), current or former smoking, and health care utilization in the previous year. Preexisting comorbidities were identified by ICD-10 codes in the previous year, including hypertension, diabetes mellitus, ischemic heart disease, peripheral vascular disease, congestive heart failure, cerebrovascular disease, renal failure, chronic obstructive pulmonary disease, asthma, obstructive sleep apnea, and cancer. For PLWH and HIV-uninfected individuals hospitalized for COVID-19, we also assessed admission to intensive care units, need for invasive mechanical ventilation, hospital discharge status, and deaths.

We conducted a manual chart review to describe COVID-19 presentation and clinical course among PLWH, reviewing any symptoms reported within 30 days before COVID-19 diagnosis. Exposure history and occupations were captured from progress notes, where available. Data were captured on HIV-related laboratory tests (ie, most recent HIV viral load and CD4+ cell counts in the previous year), exposure history, and clinical characteristics of COVID-19 infection. A detailed chart review was not conducted for HIV-uninfected patients because it was not feasible to conduct a manual chart review in this large group.

Statistical Analysis

We computed the incidence of testing, diagnosis, and hospitalization for COVID-19 among PLWH and HIV-uninfected individuals in the KPSC population. We compared the demographic and clinical characteristics at COVID-19 diagnosis by HIV status and COVID-19 hospitalization using the χ 2 test or the Fisher exact test for categorical variables and the Kruskal–Wallis test for continuous variables. Among PLWH with COVID-19, we also characterized differences in presenting symptoms and clinical course among hospitalized and nonhospitalized patients.