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

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  • Shapiro, A.E
    • Other Affiliation: University of Washington, Seattle, WA, United States
  • Bender Ignacio, R.A
    • Other Affiliation: University of Washington, Seattle, WA 98102, United States
  • Whitney, B.M
    • Other Affiliation: University of Washington, Seattle, WA, United States
  • Delaney, J.A
    • Other Affiliation: University of Manitoba, Winnipeg, Canada
  • Nance, R.M
    • Other Affiliation: University of Washington, Seattle, WA, United States
  • Bamford, L
    • Other Affiliation: University of California San Diego, San Diego, CA, United States
  • Wooten, D
    • Other Affiliation: University of California San Diego, San Diego, CA, United States
  • Keruly, J.C
    • Other Affiliation: Johns Hopkins School of Medicine, Baltimore, MD, United States
  • Burkholder, G
    • Other Affiliation: University of Alabama at Birmingham, Birmingham, AL, United States
  • Napravnik, S
    • Affiliation: University of North Carolina at Chapel Hill
  • Mayer, K.H
    • Other Affiliation: Fenway Health, Boston, MA, United States
  • Webel, A.R
    • Other Affiliation: Case Western Reserve University, Cleveland, OH, United States
  • Kim, H.N
    • Other Affiliation: University of Washington, Seattle, WA, United States
  • Van Rompaey, S.E
    • Other Affiliation: University of Washington, Box 359927, Seattle, WA 98102, United States
  • Christopoulos, K
    • Other Affiliation: University of California, San Francisco, CA, United States
  • Jacobson, J
    • Other Affiliation: Case Western Reserve University, Cleveland, OH, United States
  • Karris, M
    • Other Affiliation: University of California San Diego, San Diego, CA, United States
  • Smith, D
    • Other Affiliation: University of California San Diego, San Diego, CA, United States
  • Johnson, M.O
    • Other Affiliation: University of California, San Francisco, CA, United States
  • Willig, A
    • Other Affiliation: University of Alabama at Birmingham, Birmingham, AL, United States
  • Eron, J.J
    • Affiliation: University of North Carolina at Chapel Hill
  • Hunt, P
    • Other Affiliation: University of California, San Francisco, CA, United States
  • Moore, R.D
    • Other Affiliation: Johns Hopkins School of Medicine, Baltimore, MD, United States
  • Saag, M.S
    • Other Affiliation: University of Alabama at Birmingham, Birmingham, AL, United States
  • Mathews, W.C
    • Other Affiliation: University of California, San Francisco, CA, United States
  • Crane, H.M
    • Other Affiliation: University of Washington, Seattle, WA, United States
  • Cachay, E.R
    • Other Affiliation: University of California, San Francisco, CA, United States
  • Kitahata, M.M.
    • Other Affiliation: University of Washington, Seattle, WA, United States
Abstract
  • 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.
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DOI
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Resource type
  • Article
Rights statement
  • In Copyright
Journal title
  • Journal of Acquired Immune Deficiency Syndromes
Journal volume
  • 90
Journal issue
  • 4
Page start
  • 369
Page end
  • 376
Language
  • English
Version
  • Postprint
Funder
  • National Institute on Drug Abuse, NIDA: R01DA047045
  • P30 AI060354
  • Center for AIDS Research, University of Alabama at Birmingham, CFAR: P30 AI027767
  • P30 AI027757
  • Center for AIDS Research, Johns Hopkins University, JHU CFAR: P30 AI094189
  • Center for AIDS Research, University of North Carolina at Chapel Hill, UNC CFAR: P30 AI50410
  • National Institute of Allergy and Infectious Diseases, NIAID: CNICS R24 AI067039
  • Case Western Reserve University, CWRU: P30 AI036219
  • P30 AI036214
  • P30 AI027763
ISSN
  • 1525-4135
Publisher
  • Lippincott Williams and Wilkins

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