Disproportionate burden of coronavirus disease 2019 among racial minorities and those in congregate settings among a large cohort of people with HIV

Abstract

Background: Many people living with HIV (PLWH) have comorbidities which are risk factors for severe coronavirus disease 2019 (COVID-19) or have exposures that may lead to acquisition of severe acute respiratory distress syndrome coronavirus 2. There are few studies, however, on the demographics, comorbidities, clinical presentation, or outcomes of COVID-19 in people with HIV. Objective: To evaluate risk factors, clinical manifestations, and outcomes in a large cohort of PLWH with COVID-19. Methods: We systematically identified all PLWH who were diagnosed with COVID-19 at a large hospital from 3 March to 26 April 2020 during an outbreak in Massachusetts. We analyzed each of the cases to extract information including demographics, medical comorbidities, clinical presentation, and illness course after COVID-19 diagnosis. Results: We describe a cohort of 36 PLWH with confirmed COVID-19 and another 11 patients with probable COVID-19. Almost 85% of PLWH with confirmed COVID-19 had a comorbidity associated with severe disease, including obesity, cardiovascular disease, or hypertension. Approximately 77% of PLWH with COVID-19 were non-Hispanic Black or Latinx whereas only 40% of the PLWH in our clinic were Black or Latinx. Nearly half of PLWH with COVID-19 had exposure to congregate settings. In addition to people with confirmed COVID-19, we identified another 11 individuals with probable COVID-19, almost all of whom had negative PCR testing. Conclusion: In the largest cohort to date of PLWH and confirmed COVID-19, almost all had a comorbidity associated with severe disease, highlighting the importance of non-HIV risk factors in this population. The racial disparities and frequent link to congregate settings in PLWH and COVID-19 need to be explored urgently.

Outcomes of Coronavirus Disease 2019 (COVID-19) Related Hospitalization Among People With Human Immunodeficiency Virus (HIV) in the ISARIC World Health Organization (WHO) Clinical Characterization Protocol (UK): A Prospective Observational Study

“…Evidence about the interplay between HIV and COVID-19 is not entirely consistent [8,9,[13][14][15][16][17][18][19][20][21][22][23]. A case-control study from New York compared 88 PWH, all of whom were receiving ART, and 405 HIV-negative controls matched by age, gender, ethnicity, and calendar week of infection [21].…”

“…Several case series and observational cohort studies have described the outcomes of in PWH across Europe [9,[13][14][15][16][17][18][19], Asia [18,19], and the United States [8,[18][19][20][21][22]. These studies have often been limited by small sample sizes, lack of direct comparative data from people without HIV, or inability to adjust for comorbidities.…”

COVID-19 Related Medical Mistrust, Health Impacts, and Potential Vaccine Hesitancy Among Black Americans Living With HIV

“…Like COVID-19—and due to the same structural inequities—HIV disproportionately affects Black Americans. 38 Although limited data regarding HIV and COVID-19 co-infection are available, 39 – 42 people living with HIV may be particularly vulnerable due to overlapping comorbidities (eg, cardiovascular disease, hypertension, diabetes, and advanced age). 43 , 44 Moreover, health care system disruptions due to COVID-19 may affect access to health care and medications, and disruptions to employment, living situations, and other social determinants of health may affect adherence and general health.…”

Mental health, coping, and social support among people living with HIV in the Americas: A comparative study between Argentina and the USA during the SARS-CoV-2 pandemic

“…High-risk population for severe forms included people 60 years and older and those of any age with underlying medical conditions (e.g., chronic lung disease, asthma, heart conditions, etc) [10][11][12]. As such, people living with HIV infection (PLWH) are considered to be at greater risk for adverse outcomes due to COVID-19 [13][14][15]. Although recent retrospective analysis of hospitalized PLWH with COVID-19 do not appear to show higher rates of infection or severity among PLWH, the literature is scarce and lacks longitudinal follow up [16][17][18].…”