TY - JOUR
T1 - Factors Associated with Severity of COVID-19 Disease in a Multicenter Cohort of People with HIV in the United States, March-December 2020
AU - Shapiro, Adrienne E.
AU - Bender Ignacio, Rachel A.
AU - Whitney, Bridget M.
AU - Delaney, Joseph A.
AU - Nance, Robin M.
AU - Bamford, Laura
AU - Wooten, Darcy
AU - Keruly, Jeanne C.
AU - Burkholder, Greer
AU - Napravnik, Sonia
AU - Mayer, Kenneth H.
AU - Webel, Allison R.
AU - Kim, H. Nina
AU - Van Rompaey, Stephen E.
AU - Christopoulos, Katerina
AU - Jacobson, Jeffrey
AU - Karris, Maile
AU - Smith, Davey
AU - Johnson, Mallory O.
AU - Willig, Amanda
AU - Eron, Joseph J.
AU - Hunt, Peter
AU - Moore, Richard D.
AU - Saag, Michael S.
AU - Mathews, W. Christopher
AU - Crane, Heidi M.
AU - Cachay, Edward R.
AU - Kitahata, Mari M.
N1 - Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/8/1
Y1 - 2022/8/1
N2 - Background:Understanding the spectrum of COVID-19 in people with HIV (PWH) is critical to provide clinical guidance and risk reduction strategies.Setting:Centers for AIDS Research Network of Integrated Clinic System, a US multisite clinical cohort of PWH in care.Methods:We identified COVID-19 cases and severity (hospitalization, intensive care, and death) in a large, diverse HIV cohort during March 1, 2020-December 31, 2020. We determined predictors and relative risks of hospitalization among PWH with COVID-19, adjusted for disease risk scores.Results:Of 16,056 PWH in care, 649 were diagnosed with COVID-19 between March and December 2020. Case fatality was 2%; 106 (16.3%) were hospitalized, and 12 died. PWH with current CD4 count <350 cells/mm3[aRR 2.68; 95% confidence interval (CI): 1.93 to 3.71; P < 0.001] or lowest recorded CD4 count <200 cells/mm3(aRR 1.67; 95% CI: 1.18 to 2.36; P < 0.005) had greater risks of hospitalization. HIV viral load and antiretroviral therapy status were not associated with hospitalization, although most of the PWH were suppressed (86%). Black PWH were 51% more likely to be hospitalized with COVID-19 compared with other racial/ethnic groups (aRR 1.51; 95% CI: 1.04 to 2.19; P = 0.03). Chronic kidney disease, chronic obstructive pulmonary disease, diabetes, hypertension, obesity, and increased cardiovascular and hepatic fibrosis risk scores were associated with higher hospitalization risk. PWH who were older, not on antiretroviral therapy, and with current CD4 count <350 cells/mm3, diabetes, and chronic kidney disease were overrepresented among PWH who required intubation or died.Conclusions:PWH with CD4 count <350 cells/mm3, and a history of CD4 count <200 cells/mm3, have a clear excess risk of severe COVID-19, accounting for comorbidities associated with severe outcomes. PWH with these risk factors should be prioritized for COVID-19 vaccination and early treatment and monitored closely for worsening illness.
AB - Background:Understanding the spectrum of COVID-19 in people with HIV (PWH) is critical to provide clinical guidance and risk reduction strategies.Setting:Centers for AIDS Research Network of Integrated Clinic System, a US multisite clinical cohort of PWH in care.Methods:We identified COVID-19 cases and severity (hospitalization, intensive care, and death) in a large, diverse HIV cohort during March 1, 2020-December 31, 2020. We determined predictors and relative risks of hospitalization among PWH with COVID-19, adjusted for disease risk scores.Results:Of 16,056 PWH in care, 649 were diagnosed with COVID-19 between March and December 2020. Case fatality was 2%; 106 (16.3%) were hospitalized, and 12 died. PWH with current CD4 count <350 cells/mm3[aRR 2.68; 95% confidence interval (CI): 1.93 to 3.71; P < 0.001] or lowest recorded CD4 count <200 cells/mm3(aRR 1.67; 95% CI: 1.18 to 2.36; P < 0.005) had greater risks of hospitalization. HIV viral load and antiretroviral therapy status were not associated with hospitalization, although most of the PWH were suppressed (86%). Black PWH were 51% more likely to be hospitalized with COVID-19 compared with other racial/ethnic groups (aRR 1.51; 95% CI: 1.04 to 2.19; P = 0.03). Chronic kidney disease, chronic obstructive pulmonary disease, diabetes, hypertension, obesity, and increased cardiovascular and hepatic fibrosis risk scores were associated with higher hospitalization risk. PWH who were older, not on antiretroviral therapy, and with current CD4 count <350 cells/mm3, diabetes, and chronic kidney disease were overrepresented among PWH who required intubation or died.Conclusions:PWH with CD4 count <350 cells/mm3, and a history of CD4 count <200 cells/mm3, have a clear excess risk of severe COVID-19, accounting for comorbidities associated with severe outcomes. PWH with these risk factors should be prioritized for COVID-19 vaccination and early treatment and monitored closely for worsening illness.
KW - CD4 count
KW - COVID-19
KW - HIV
KW - immunosuppression
KW - structural determinants of health
UR - http://www.scopus.com/inward/record.url?scp=85133102639&partnerID=8YFLogxK
U2 - 10.1097/QAI.0000000000002989
DO - 10.1097/QAI.0000000000002989
M3 - Article
C2 - 35364600
AN - SCOPUS:85133102639
SN - 1525-4135
VL - 90
SP - 369
EP - 376
JO - Journal of Acquired Immune Deficiency Syndromes
JF - Journal of Acquired Immune Deficiency Syndromes
IS - 4
ER -