Coronavirus 2019 and People Living With Human Immunodeficiency Virus: Outcomes for Hospitalized Patients in New York City

Abstract

Background There have been limited data regarding the clinical impact of COVID-19 disease on people with HIV (PWH). In this study we compared outcomes for PWH with COVID-19 disease to a matched comparison group. Design We identified 88 PWH hospitalized with laboratory confirmed COVID-19 in our hospital system in New York between March 12 and April 23, 2020. We collected data on baseline clinical characteristics, laboratory values, HIV infection status, COVID-19 treatment, and outcomes from this group and matched comparators (one PWH to up to five patients by age, sex, race/ethnicity and calendar week of infection). We compared baseline clinical characteristics and outcomes (death, mechanical ventilation, hospital discharge) for these two groups, as well as cumulative incidence of death by HIV status. Results Patients did not differ significantly by HIV status by age, sex or race/ethnicity due to the matching algorithm. PWH hospitalized with COVID-19 had high proportions of HIV virologic control on antiretroviral therapy. PWH had greater proportions of smoking (p<0.001) and comorbid illness than demographically similar uninfected comparators. There was no difference in COVID-19 severity on admission by HIV status (p=0.15). Poor outcomes for hospitalized PWH were frequent but similar to proportions in comparators; 18% required mechanical ventilation and ultimately 21% died during follow-up (compared with 23% and 20% respectively). There was similar cumulative incidence of death over time by HIV status (p=0.94). Interpretation We found no differences in adverse outcomes associated with HIV infection for hospitalized COVID-19 patients compared to a demographically similar patient group.

Population Risk Factors for COVID-19 Deaths in Nigeria at Subnational Level

“…Previously studies have suggested that BCG vaccination may have a protective role in COVID-19 disease severity [16][17][18]. Although BCG was developed to protect against Mycobacterium tuberculosis, the causative agent of tuberculosis, it has been reported to induce cross-protective trained immunity against a number of viral and bacterial pathogens [19][20][21]. In this study, we found that low BCG vaccine coverage correlated with higher COVID-19 mortality.…”

“…Although it was expected, and with good reason, that HIV patients may succumb to more severe COVID-19 infection and mortality, our data does not appear to support this. Indeed, a few recent reports also indicate that HIV patients are at no greater risk of severe COVID-19 compared to the general population [19][20][21]24]. Why people with HIV do not develop more severe COVID-19 remains puzzling.…”

Ethnicity and clinical outcomes in COVID-19: A systematic review and meta-analysis

“…Several studies may have overlapping populations [84] . For example, we found several studies from Mount Sinai investigating mortality from COVID-19; quite possibly from the same population [ 53 , [85] , [86] , [87] , [88] ]. We have minimised this error by excluding studies which were clearly done on the same database, though we urge greater transparency in reporting for future research.…”

COVID-19 in patients with HIV-1 infection: a single-centre experience in northern Italy

“…In another report of 88 HIV-infected patients with COVID-19 hospitalized in New York City, there were no differences in adverse outcomes in comparison with a demographically similar patient group. Moreover, HIV-positive patients had greater proportions of smoking and comorbidities than similar HIV-negative comparators [ 15 ]. Therefore, in these cohorts, SARS-CoV-2 infections do not seem to act as an opportunistic pathogen in the setting of HIV disease.…”