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

Abstract

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.

COVID-19 Outcomes and Risk Factors Among People Living with HIV

“…In a population-based study from the Western Cape Province, South Africa, which included 540,552 PLWH, the cumulative incidence of SARS-CoV-2 infection through June 9, 2020, was similar by HIV status (0.74% vs. 0.63%) [35]. Cohorts from large health systems have instead been more mixed, with higher incidence of COVID-19 with the University of California, San Diego health system [40], and Kaiser Permanente Southern California [41], but similar incidence within the U.S. Veteran Administration Veterans Aging Cohort [38] and the San Francisco Department of Public Health Clinics [36].…”

COVID‐19 hospitalization outcomes in adults by HIV status; a nation‐wide register‐based study

“…This study also lacked data regarding smoking status, although this was partly compensated by adjusting for chronic lung disease. Given that our study population only includes hospitalized people, we could not assess factors influencing the risk of hospitalization, for example higher test probability for SARS-CoV-2 for PWH, which has been shown in a recent report from the US [26]. It is also possible that restricting the population to hospitalized people introduces collider bias, i.e.…”

Immunogenicity of COVID-19 Vaccination in People Living with HIV: Progress and Challenges

“…Although no clinical evidence demonstrates the higher prevalence of COVID-19 or COVID-19 diagnosis rate in PLWH than in the general population, [9,27–30] more studies in large-scale population suggested that PLWH might have increased risk of COVID-19–related hospitalization or death than healthy individuals. [28,29,31–36] Residual inflammation and immune activation even after successful ART, as well as the high rate of comorbidities in PLWH, might result in poor COVID-19 outcomes.…”