Factors Associated With Severity of COVID-19 Disease in a Multicenter Cohort of People With HIV in the United States, March–December 2020

Shapiro, Adrienne E.; Ignacio, Rachel A. Bender; Whitney, Bridget M; Delaney, Joseph A.; Nance, Robin M.; Bamford, Laura; Wooten, Darcy; Keruly, Jeanne C.; Burkholder, Greer A.; Napravnik, Sonia; Mayer, Kenneth H.; Webel, Allison R.; Kim, H. Nina; Rompaey, Stephen E. Van; Christopoulos, Katerina; Jacobson, Jeffrey M.; Karris, Maile Y.; Smith, Davey M; Johnson, Mallory O.; Willig, Amanda L.; Eron, Joseph J.; Hunt, Peter W.; Moore, Richard D.; Saag, Michael S.; Mathews, W. Christopher; Crane, Heidi M.; Cachay, Edward R.; Kitahata, Mari M.

doi:10.1097/qai.0000000000002989

Cited by 27 publications

(36 citation statements)

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“…Older PWH who have lived through the first decades of the AIDS pandemic, especially those with personal experience of AIDS, may have been more likely to limit social interactions or request work accommodations during 2020 [43,44]. However, once infected, older PWH were more likely to experience severe outcomes of COVID-19 infection, including hospitalization, ICU admission, and death as we previously reported in this cohort [22].…”

Section: Discussionsupporting

confidence: 52%

“…The remaining 23% of cases were verified from a variety of sources, including PCR and antigen testing performed in community or public health settings or at non-CNICS-affiliated medical sites. As previously reported, 108 patients (16.3%) were hospitalized, and 12 (1.9%) died; cases detected incidentally on hospital admission or preprocedural testing were included as cases, but not as hospitalizations [22].…”

Section: Resultsmentioning

confidence: 99%

“…There are significant geographic, racial/ ethnic, and income disparities in the distribution of these comorbidities among PWH compared with the general population [21]. It is essential to elucidate the role these factors play in COVID-19 incidence, separately from factors that may increase severity of COVID-19 disease in PWH [22]. We conducted this study in the longstanding Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) multisite United States cohort of PWH.…”

Section: Introductionmentioning

confidence: 99%

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Racial and ethnic disparities in coronavirus disease 2019 disease incidence independent of comorbidities, among people with HIV in the United States

Ignacio

Shapiro

Nance

et al. 2022

Aids

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Objectives: To define the incidence of clinically detected coronavirus disease 2019 in people with HIV (PWH) in the United States and evaluate how racial and ethnic disparities, comorbidities, and HIV-related factors contribute to risk of COVID-19.Design: Observational study within the CFAR Network of Integrated Clinical Systems cohort in seven cities during 2020. Methods:We calculated cumulative incidence rates of COVID-19 diagnosis among PWH in routine care by key characteristics including race/ethnicity, current and lowest CD4 þ cell count, and geographic area. We evaluated risk factors for COVID-19 among PWH using relative risk regression models adjusted with disease risk scores.Results: Among 16 056 PWH in care, of whom 44.5% were black, 12.5% were Hispanic, with a median age of 52 years (IQR 40-59), 18% had a current CD4 þ cell count less than 350 cells/ml, including 7% less than 200; 95.5% were on antiretroviral therapy (ART), and 85.6% were virologically suppressed. Overall in 2020, 649 PWH were diagnosed with COVID-19 for a rate of 4.94 cases per 100 person-years. The cumulative incidence of COVID-19 was 2.4-fold and 1.7-fold higher in Hispanic and black PWH respectively, than non-Hispanic white PWH.

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Section: Discussionsupporting

confidence: 52%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Racial and ethnic disparities in coronavirus disease 2019 disease incidence independent of comorbidities, among people with HIV in the United States

Ignacio

Shapiro

Nance

et al. 2022

Aids

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“…Hence, our findings cannot be generalized to PWH populations with higher proportions of unsuppressed viraemia. Similarly, we did not assess nadir CD4 counts, which some have suggested is a more reliable marker of immunosuppression risk for severe COVID‐19 among PWH [ 33 ]. Fifth, although we took into account comprehensive comorbidity measures in estimating effects, residual sources of bias and confounding may remain.…”

Section: Discussionmentioning

confidence: 99%

People with HIV have a higher risk of COVID‐19 diagnosis but similar outcomes to the general population

et al. 2022

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Background We investigated the effect of HIV on COVID‐19 outcomes with attention to selection bias due to differential testing and comorbidity burden. Methods This was a retrospective cohort analysis using four hierarchical outcomes: positive SARS‐CoV‐2 test, COVID‐19 hospitalization, intensive care unit (ICU) admission and hospital mortality. The effect of HIV status was assessed using traditional covariate‐adjusted, inverse probability‐weighted (IPW) analysis based on covariate distributions for testing bias (testing IPWs), HIV infection status (HIV‐IPWs) and combined models. Among people living with HIV (PWH), we evaluated whether CD4 count and HIV plasma viral load (pVL) discriminated between those who did and those who did not develop study outcomes using receiver operating characteristic analysis. Results Between March and November 2020, 63 319 people were receiving primary care services at the University of California San Diego (UCSD), of whom 4017 were PWH. The PWH had 2.1 times the odds of a positive SARS‐CoV‐2 test compared with those without HIV after weighting for potential testing bias, comorbidity burden and HIV‐IPW [95% confidence interval (CI): 1.6–2.8]. Relative to people without HIV, PWH did not have an increased rate of COVID‐19 hospitalization after controlling for comorbidities and testing bias [adjusted incidence rate ratio (aIRR) = 0.5, 95% CI: 0.1–1.4]. PWH did not have a different rate of ICU admission (aIRR = 1.08, 95% CI: 0.31–3.80) or of in‐hospital death (aIRR = 0.92, 95% CI: 0.08–10.94) in any examined model. Neither CD4 count nor pVL predicted any of the hierarchical outcomes among PWH. Conclusions People living with HIV have a higher risk of COVID‐19 diagnosis than those without HIV but the outcomes are similar in both groups.

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“…A WHO report, based on surveillance data from 37 countries between 01 January 2020 and 29 April 2021, demonstrated that PLWH hospitalized with COVID‐19 had an increased risk of severe disease and in‐hospital mortality than people without HIV [23]. For PLWH with severe immunosuppression or uncontrolled HIV viraemia, fatality rates for COVID‐19 remain uncertain [19,20,24,25], although recent evidence suggests that these individuals have a higher risk of severe COVID‐19 disease [26,27]. Similarly, a higher risk of complications from COVID‐19 has been reported among PLWH with a low CD4 + T cell count nadir prior to ART initiation compared to those with higher nadirs [28].…”

Section: Introductionmentioning

confidence: 99%

Mitigation strategies to safely conduct HIV treatment research in the context of COVID‐19

et al. 2022

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Introduction The International AIDS Society convened a multidisciplinary committee of experts in December 2020 to provide guidance and key considerations for the safe and ethical management of clinical trials involving people living with HIV (PLWH) during the SARS‐CoV‐2 pandemic. This consultation did not discuss guidance for the design of prevention studies for people at risk of HIV acquisition, nor for the programmatic delivery of antiretroviral therapy (ART). Discussion There is strong ambition to continue with HIV research from both PLWH and the research community despite the ongoing SARS‐CoV‐2 pandemic. How to do this safely and justly remains a critical debate. The SARS‐CoV‐2 pandemic continues to be highly dynamic. It is expected that with the emergence of effective SARS‐CoV‐2 prevention and treatment strategies, the risk to PLWH in clinical trials will decline over time. However, with the emergence of more contagious and potentially pathogenic SARS‐CoV‐2 variants, the effectiveness of current prevention and treatment strategies may be compromised. Uncertainty exists about how equally SARS‐CoV‐2 prevention and treatment strategies will be available globally, particularly for marginalized populations, many of whom are at high risk of reduced access to ART and/or HIV disease progression. All of these factors must be taken into account when deciding on the feasibility and safety of developing and implementing HIV research. Conclusions It can be assumed for the foreseeable future that SARS‐CoV‐2 will persist and continue to pose challenges to conducting clinical research in PLWH. Guidelines regarding how best to implement HIV treatment studies will evolve accordingly. The risks and benefits of performing an HIV clinical trial must be carefully evaluated in the local context on an ongoing basis. With this document, we hope to provide a broad guidance that should remain viable and relevant even as the nature of the pandemic continues to develop.

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Factors Associated With Severity of COVID-19 Disease in a Multicenter Cohort of People With HIV in the United States, March–December 2020

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 27 publications

References 59 publications

Racial and ethnic disparities in coronavirus disease 2019 disease incidence independent of comorbidities, among people with HIV in the United States

Racial and ethnic disparities in coronavirus disease 2019 disease incidence independent of comorbidities, among people with HIV in the United States

People with HIV have a higher risk of COVID‐19 diagnosis but similar outcomes to the general population

Mitigation strategies to safely conduct HIV treatment research in the context of COVID‐19

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