Sociodemographic, clinical, and immunological factors associated with SARS-CoV-2 diagnosis and severe COVID-19 outcomes in people living with HIV: a retrospective cohort study
- PMID: 34655549
- PMCID: PMC8514194
- DOI: 10.1016/S2352-3018(21)00240-X
Sociodemographic, clinical, and immunological factors associated with SARS-CoV-2 diagnosis and severe COVID-19 outcomes in people living with HIV: a retrospective cohort study
Abstract
Background: Factors affecting outcomes of SARS-CoV-2 infection in people living with HIV are unclear. We assessed the factors associated with SARS-CoV-2 diagnosis and severe outcomes among people living with HIV.
Methods: We did a retrospective cohort study using data from the PISCIS cohort of people with HIV in Catalonia (Spain) between March 1 and Dec 15, 2020. We linked PISCIS data with integrated health-care, clinical, and surveillance registries through the Public Data Analysis for Health Research and Innovation Program of Catalonia (PADRIS) to obtain data on SARS-CoV-2 diagnosis, chronic comorbidities, as well as clinical and mortality outcomes. Participants were aged at least 16 years in care at 16 hospitals in Catalonia. Factors associated with SARS-CoV-2 diagnoses and severe outcomes were assessed using univariable and multivariable Cox regression models. We estimated the effect of immunosuppression on severe outcomes (hospital admission for >24 h with dyspnoea, tachypnoea, hypoxaemia, asphyxia, or hyperventilation; or death) using Kaplan-Meier survival analysis.
Findings: We linked 20 847 (72·8%) of 28 666 participants in the PISCIS cohort with PADRIS data; 13 142 people had HIV. 749 (5·7%) people with HIV were diagnosed with SARS-CoV-2: their median age was 43·5 years (IQR 37·0-52·7), 131 (17·5%) were female, and 618 (82·5%) were male. 103 people with HIV (13·8%) were hospitalised, seven (0·9%) admitted to intensive care, and 13 (1·7%) died. SARS-CoV-2 diagnosis was more common among migrants (adjusted hazard ratio 1·55, 95% CI 1·31-1·83), men who have sex with men (1·42, 1·09-1·86), and those with four or more chronic comorbidities (1·46, 1·09-1·97). Age at least 75 years (5·2, 1·8-15·3), non-Spanish origin (2·1, 1·3-3·4), and neuropsychiatric (1·69, 1·07-2·69), autoimmune disease (1·92, 1·14-3·23), respiratory disease (1·84, 1·09-3·09), and metabolic disease (2·59, 1·59-4·23) chronic comorbidities were associated with increased risk of severe outcomes. A Kaplan-Meier estimator showed differences in the risk of severe outcomes according to CD4 cell count in patients with detectable HIV RNA (p=0·039) but no differences were observed in patients with undetectable HIV RNA (p=0·15).
Interpretation: People living with HIV with detectable HIV viraemia, chronic comorbidities, and some subpopulations could be at increased risk of severe outcomes from COVID-19. These groups should be prioritised in clinical management and SARS-CoV-2 vaccination programmes.
Funding: Fundació "la Caixa".
Translations: For the Catalan, Spanish and Russian translations of the Summary see Supplementary Materials section.
Copyright © 2021 Elsevier Ltd. All rights reserved.
Conflict of interest statement
Declaration of interests JMM reports receiving a personal 80:20 research grant from Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain, during 2017–21. EL reports receiving honoraria for lectures and presentations from ViiV Healthcare, Gilead Sciences, and Jansen Therapeutics; travel support for attending meetings from ViiV Healthcare and Jansen Therapeutics; payments for participating in the data safety monitoring and advisory board of ViiV Healthcare; being a full time employee of ViiV Healthcare since May 3, 2020; and payments made from Juan Rodés to the Spanish Government on his behalf. PD reports that his institution received grants from Gilead Sciences, Janssen-Cilag, and ViiV Healthcare; and he personally received honoraria from Gilead Sciences, Janssen-Cilag, Merck Sharp & Dohme, ViiV Healthcare, Roche, and Thera Technologies. AI reports that his institution received grants from Gilead Sciences and Merck Sharp & Dohme; and he personally received consultation fees from Gilead Sciences, ViiV Healthcare, and Thera Technologies; honoraria for lectures and presentations from Gilead Sciences, Merck Sharp & Dohme, Jansen Therapeutics, and ViiV Healthcare; and travel support for attending meetings from Gilead Sciences, Jansen, and ViiV Healthcare. VF reports that his institution received grants from Gilead Sciences, ViiV Healthcare, and Merck Sharp & Dohme; and he personally received consultation fees from ViiV Healthcare; honoraria for lectures and presentations from ViiV Healthcare, Gilead Sciences, Jansen Therapeutics, and Merck Sharp & Dohme; and travel support for attending meetings from Gilead Sciences. All other authors declare no competing interests.
Figures
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Comment in
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More evidence for worse COVID-19 outcomes in people with HIV.Lancet HIV. 2021 Nov;8(11):e661-e662. doi: 10.1016/S2352-3018(21)00272-1. Epub 2021 Oct 13. Lancet HIV. 2021. PMID: 34655548 Free PMC article. No abstract available.
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References
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