Outcomes of Coronavirus Disease 2019 (COVID-19) Related Hospitalization Among People With Human Immunodeficiency Virus (HIV) in the ISARIC World Health Organization (WHO) Clinical Characterization Protocol (UK): A Prospective Observational Study.

Anna Maria Geretti,Peter J M Openshaw,Lance Turtle,Ewen M Harrison,Laura Waters,Giovanni Villa,Muge Cevik,Annemarie Docherty,Sophie H Kelly,Caroline A Sabin,J Kenneth Baillie,Malcolm G Semple,Simon Collins,Alexander J Stockdale

doi:10.1093/cid/ciaa1605

Abstract

BackgroundEvidence is conflicting about how human immunodeficiency virus (HIV) modulates coronavirus disease 2019 (COVID-19). We compared the presentation characteristics and outcomes of adults with and without HIV who were hospitalized with COVID-19 at 207 centers across the United Kingdom and whose data were prospectively captured by the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) World Health Organization (WHO) Clinical Characterization Protocol (CCP) study.MethodsWe used Kaplan-Meier methods and Cox regression to describe the association between HIV status and day-28 mortality, after separate adjustment for sex, ethnicity, age, hospital acquisition of COVID-19 (definite hospital acquisition excluded), presentation date, 10 individual comorbidities, and disease severity at presentation (as defined by hypoxia or oxygen therapy).ResultsAmong 47 592 patients, 122 (0.26%) had confirmed HIV infection, and 112/122 (91.8%) had a record of antiretroviral therapy. At presentation, HIV-positive people were younger (median 56 vs 74 years; P < .001) and had fewer comorbidities, more systemic symptoms and higher lymphocyte counts and C-reactive protein levels. The cumulative day-28 mortality was similar in the HIV-positive versus HIV-negative groups (26.7% vs. 32.1%; P = .16), but in those under 60 years of age HIV-positive status was associated with increased mortality (21.3% vs. 9.6%; P < .001 [log-rank test]). Mortality was higher among people with HIV after adjusting for age (adjusted hazard ratio [aHR] 1.47, 95% confidence interval [CI] 1.01–2.14; P = .05), and the association persisted after adjusting for the other variables (aHR 1.69; 95% CI 1.15–2.48; P = .008) and when restricting the analysis to people aged <60 years (aHR 2.87; 95% CI 1.70–4.84; P < .001).ConclusionsHIV-positive status was associated with an increased risk of day-28 mortality among patients hospitalized for COVID-19.

Highlights

Older age and presence of comorbidities including immunosuppression are recognized to increase the severity of COVID-19 [1-5]
Principal findings This study found evidence suggesting an age-adjusted 47% increased risk of day-28 mortality among people with HIV (PWH) hospitalized with COVID-19 compared to HIV-negative individuals in the same dataset
Among people aged

Summary

Introduction

Older age and presence of comorbidities including immunosuppression are recognized to increase the severity of COVID-19 [1-5]. Despite effective antiretroviral therapy (ART), people with HIV (PWH) may continue to experience persistent immunodysfunction [6, 7] which might promote COVID-19 severity, or attenuate its pathological immune t responses [8]. Man Several case series and observational cohort studies have described the outcomes of COVID-19 in PWH across Europe [9,13-19], Asia [18,19], and the United States [8,18-22] These studies d have often been limited by small sample sizes, lack of direct comparative data from people te without HIV, or inability to adjust for comorbidities. Some reports indicated that PWH did not p experience higher rates of COVID-19 related hospitalization or mortality than people without ce HIV [14,21], whereas others suggested increased disease severity [9,20]. Conclusions HIV-positive status was associated with an increased risk of day-28 mortality among patients hospitalized for COVID-19

Methods

Findings

Discussion

Conclusion