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

Ignacio, Rachel A. Bender; Shapiro, Adrienne E.; Nance, Robin M.; Whitney, Bridget M; Delaney, Joseph A.; Bamford, Laura; Wooten, Darcy; Karris, Maile Y.; Mathews, William C; Kim, Hyang Nina; Keruly, Jeanne C.; Burkholder, Greer A.; Napravnik, Sonia; Mayer, Kenneth H.; Jacobson, Jeffrey M.; Saag, Michael S.; Moore, Richard D.; Eron, Joseph J.; Willig, Amanda L.; Christopoulos, Katerina; Martin, Jeffrey N.; Hunt, Peter W.; Crane, Heidi M.; Kitahata, Mari M.

doi:10.1097/qad.0000000000003223

Cited by 11 publications

(5 citation statements)

References 54 publications

(62 reference statements)

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“…Our findings that low current CD4 cell count and HIV viraemia are associated with COVID-19 mortality concur with several studies [4,7,8,[19][20][21][22][23][24]. We also found strong associations of mortality with nadir CD4 as previously reported from a large US cohort [25], recent HIV diagnosis, and previous and especially recent/current tuberculosis co-infection [7]. These characteristics all suggest previous delayed HIV diagnosis and/or untreated or advanced HIV, highlighting the importance of strengthening HIV and tuberculosis care programmes to reduce vulnerability to SARS-CoV-2 and other infections.…”

Section: Discussionsupporting

confidence: 93%

COVID‐19 among adults living with HIV: correlates of mortality among public sector healthcare users in Western Cape, South Africa

et al. 2023

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Introduction While a large proportion of people with HIV (PWH) have experienced SARS‐CoV‐2 infections, there is uncertainty about the role of HIV disease severity on COVID‐19 outcomes, especially in lower‐income settings. We studied the association of mortality with characteristics of HIV severity and management, and vaccination, among adult PWH. Methods We analysed observational cohort data on all PWH aged ≥15 years experiencing a diagnosed SARS‐CoV‐2 infection (until March 2022), who accessed public sector healthcare in the Western Cape province of South Africa. Logistic regression was used to study the association of mortality with evidence of antiretroviral therapy (ART) collection, time since first HIV evidence, CD4 cell count, viral load (among those with evidence of ART collection) and COVID‐19 vaccination, adjusting for demographic characteristics, comorbidities, admission pressure, location and time period. Results Mortality occurred in 5.7% (95% CI: 5.3,6.0) of 17,831 first‐diagnosed infections. Higher mortality was associated with lower recent CD4, no evidence of ART collection, high or unknown recent viral load and recent first HIV evidence, differentially by age. Vaccination was protective. The burden of comorbidities was high, and tuberculosis (especially more recent episodes of tuberculosis), chronic kidney disease, diabetes and hypertension were associated with higher mortality, more strongly in younger adults. Conclusions Mortality was strongly associated with suboptimal HIV control, and the prevalence of these risk factors increased in later COVID‐19 waves. It remains a public health priority to ensure PWH are on suppressive ART and vaccinated, and manage any disruptions in care that occurred during the pandemic. The diagnosis and management of comorbidities, including for tuberculosis, should be optimized.

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Section: Discussionsupporting

confidence: 93%

COVID‐19 among adults living with HIV: correlates of mortality among public sector healthcare users in Western Cape, South Africa

et al. 2023

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“…Many social and economic barriers placed certain racial/ethnic communities at higher risk of complications and death from COVID-19 [32], especially in those also living with HIV. A recent study showed that the cumulative incidence of COVID-19 was 2.4-and 1.7-fold higher in Hispanic and non-Hispanic Black PLWH, respectively, than non-Hispanic White PLWH [33]. Additionally, our data demonstrated a significant difference in observed and projected mortality in the non-Hispanic American Indian/Alaskan Native subgroup.…”

Section: Discussionsupporting

confidence: 55%

HIV‐related mortality in the United States during the COVID‐19 pandemic: A population‐based study

Fox

et al. 2023

J Intern Med

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Background US progress toward ending the HIV epidemic was disrupted during the COVID‐19 pandemic. Objectives To determine the impact of the pandemic on HIV‐related mortality and potential disparities. Methods Using data from the Centers for Disease Control and Prevention and the United States (US) Census Bureau, HIV‐related mortality data of decedents aged ≥25 years between 2012 and 2021 were analyzed. Excess HIV‐related mortality rates were estimated by determining the difference between observed and projected mortality rates during the pandemic. The trends of mortality were quantified with joinpoint regression analysis. Results Of the 79,725 deaths documented in adults aged 25 years and older between 2012 and 2021, a significant downward trend was noted in HIV‐related mortality rates before the pandemic, followed by a surge during the pandemic. The observed mortality rates were 18.8% (95% confidence interval [CI]: 13.1%–25.5%) and 25.4% (95%CI: 19.9%–30.4%) higher than the projected values in 2020 and 2021, respectively. Both of these percentages were higher than that in the general population in 2020 (16.4%, 95%CI: 14.9%–17.9%) and 2021 (19.8%, 95%CI: 18.0%–21.6%), respectively. Increased HIV‐related mortality was observed across all age subgroups, but those aged 25–44 years demonstrated the greatest relative increase and the lowest COVID‐19‐related deaths when compared to middle‐ and old‐aged decedents. Disparities were observed across racial/ethnic subgroups and geographic regions. Conclusions The pandemic led to a reversal in the attainments made to reduce the prevalence of HIV. Individuals living with HIV were disproportionately affected during the pandemic. Thoughtful policies are needed to address the disparity in excess HIV‐related mortality.

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“…There are currently alarming health disparities such as inadequate access to healthcare among Hispanic communities, especially among those with pre-existing health conditions. These inequities place individuals at a higher risk of severe or fatal disease as shown by previous work [ 6 , 37 ]. Determining the impacts of COVID-19 infection within at-heightened-risk populations is of vital importance.…”

Section: Discussionmentioning

confidence: 61%

Health disparities in COVID-19: immune and vascular changes are linked to disease severity and persist in a high-risk population in Riverside County, California

Bergersen,

Pham,

et al. 2023

BMC Public Health

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Background Health disparities in underserved communities, such as inadequate healthcare access, impact COVID-19 disease outcomes. These disparities are evident in Hispanic populations nationwide, with disproportionately high infection and mortality rates. Furthermore, infected individuals can develop long COVID with sustained impacts on quality of life. The goal of this study was to identify immune and endothelial factors that are associated with COVID-19 outcomes in Riverside County, a high-risk and predominantly Hispanic community, and investigate the long-term impacts of COVID-19 infection. Methods 112 participants in Riverside County, California, were recruited according to the following criteria: healthy control (n = 23), outpatients with moderate infection (outpatient, n = 33), ICU patients with severe infection (hospitalized, n = 33), and individuals recovered from moderate infection (n = 23). Differences in outcomes between Hispanic and non-Hispanic individuals and presence/absence of co-morbidities were evaluated. Circulating immune and vascular biomarkers were measured by ELISA, multiplex analyte assays, and flow cytometry. Follow-up assessments for long COVID, lung health, and immune and vascular changes were conducted after recovery (n = 23) including paired analyses of the same participants. Results Compared to uninfected controls, the severe infection group had a higher proportion of Hispanic individuals (n = 23, p = 0.012) than moderate infection (n = 8, p = 0.550). Disease severity was associated with changes in innate monocytes and neutrophils, lymphopenia, disrupted cytokine production (increased IL-8 and IP-10/CXCL10 but reduced IFNλ2/3 and IFNγ), and increased endothelial injury (myoglobin, VCAM-1). In the severe infection group, a machine learning model identified LCN2/NGAL, IL-6, and monocyte activation as parameters associated with fatality while anti-coagulant therapy was associated with survival. Recovery from moderate COVID infection resulted in long-term immune changes including increased monocytes/lymphocytes and decreased neutrophils and endothelial markers. This group had a lower proportion of co-morbidities (n = 8, p = 1.0) but still reported symptoms associated with long COVID despite recovered pulmonary function. Conclusion This study indicates increased severity of COVID-19 infection in Hispanic individuals of Riverside County, California. Infection resulted in immunological and vascular changes and long COVID symptoms that were sustained for up to 11 months, however, lung volume and airflow resistance was recovered. Given the immune and behavioral impacts of long COVID, the potential for increased susceptibility to infections and decreased quality of life in high-risk populations warrants further investigation.

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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

Cited by 11 publications

References 54 publications

COVID‐19 among adults living with HIV: correlates of mortality among public sector healthcare users in Western Cape, South Africa

COVID‐19 among adults living with HIV: correlates of mortality among public sector healthcare users in Western Cape, South Africa

HIV‐related mortality in the United States during the COVID‐19 pandemic: A population‐based study

Health disparities in COVID-19: immune and vascular changes are linked to disease severity and persist in a high-risk population in Riverside County, California

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