Multicenter Study of Outcomes Among Persons With HIV Who Presented to US Emergency Departments With Suspected SARS-CoV-2

Christopher L. Bennett, MD, MA; Emmanuel Ogele, MD; Nicholas R. Pettit, DO, PhD; Jason J. Bischof, MD; Tong Meng, MPP; Prasanthi Govindarajan, MBBS, MAS; Carlos A. Camargo, Jr, MD, DrPH; Kristen Nordenholz, MD, MSC; Jeffrey A. Kline, MD

Disclosures

J Acquir Immune Defic Syndr. 2021;88(4):406-413. 

In This Article

Abstract and Introduction

Abstract

Background: There is a need to characterize patients with HIV with suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Setting: Multicenter registry of patients from 116 emergency departments in 27 US states.

Methods: Planned secondary analysis of patients with suspected SARS-CoV-2, with (n = 415) and without (n = 25,306) HIV. Descriptive statistics were used to compare patient information and clinical characteristics by SARS-CoV-2 and HIV status. Unadjusted and multivariable models were used to explore factors associated with death, intubation, and hospital length of stay. Kaplan–Meier curves were used to estimate survival by SARS-CoV-2 and HIV infection status.

Results: Patients with both SARS-CoV-2 and HIV and patients with SARS-CoV-2 but without HIV had similar admission rates (62.7% versus 58.6%, P = 0.24), hospitalization characteristics [eg, rates of admission to the intensive care unit from the emergency department (5.0% versus 6.3%, P = 0.45) and intubation (10% versus 13.3%, P = 0.17)], and rates of death (13.9% versus 15.1%, P = 0.65). They also had a similar cumulative risk of death (log-rank P = 0.72). However, patients with both HIV and SARS-CoV-2 infections compared with patients with HIV but without SAR-CoV-2 had worsened outcomes, including increased mortality (13.9% versus 5.1%, P < 0.01, log-rank P < 0.0001) and their deaths occurred sooner (median 11.5 versus 34 days, P < 0.01).

Conclusions: Among emergency department patients with HIV, clinical outcomes associated with SARS-CoV-2 infection are not worse when compared with patients without HIV, but SARS-CoV-2 infection increased the risk of death in patients with HIV.

Introduction

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a leading cause of death in the United States.[1] Despite extensive attempts to characterize SARS-CoV-2 infections and the concurrent pandemic in the broader medical literature,[2,3] less is known about SARS-CoV-2 in patients infected with HIV—either the characteristics of those who become infected with SARS-CoV-2 or the clinical outcomes that stem from concurrent HIV and SARS-CoV-2 infection.[4–10]

This is despite a population of over 1 million individuals in the United States infected with HIV and a clear public health need for more information on the topic.[11,12] HIV can be treated with antiretroviral medication; the introduction of such therapies has increased life expectancy for patients with HIV. However, patients with HIV suffer from excess morbidity (eg, higher rates of diabetes, hypertension, chronic kidney disease, and cerebrovascular accidents compared with individuals without HIV infection).[13] This morbidity could portend that those with HIV and concurrent SARS-CoV-2 infection may have worse outcomes than individuals without HIV.[4,14] Depending on treatment effectiveness, persons with HIV infection can have a wide range of immunocompetency and therefore vulnerability to severity of viral infection.[4,13,14]

Thus, there is an urgent need to characterize the clinical features and outcomes of a large and heterogenous sample of patients with HIV and SARS-CoV-2 infections. This multicenter study helps address the current need for clinical information on SARS-CoV-2 in patients with HIV. We use a national registry of hospitals to assess a population of patients with and without HIV presenting to US emergency departments (EDs) with suspected SARS-CoV-2 infections.[15,16] Our first objective was to present and compare clinical characteristics and outcomes of a population of patients (stratified by the presence or absence of HIV and presence or absence of SARS-CoV-2 infection) presenting to US EDs with a suspected SARS-CoV-2 infection. Our second objective was to explore factors associated with both primary (death) and secondary (intubation and hospital length of stay) outcomes among the subpopulation with HIV. Our third objective was to compare survival estimates stratified by HIV and SARS-CoV-2 infection status.

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