In a recent study posted to the medRxiv* preprint server, researchers determined the effect of the human immunodeficiency virus (HIV) on coronavirus disease 2019 (COVID-19) diagnosis and disease outcomes and compared the results to those without HIV.
Study: People with HIV Have Higher Risk of COVID-19 Diagnosis but Similar Outcomes than the General Population. Image Credit: Tomas Ragina/Shutterstock
Background
Since the beginning of the COVID-19 pandemic, many have been concerned that people with HIV (PWH) might encounter a more severe course of COVID-19 than the people without HIV due to the impaired inflammatory cell responses in PWH, leading to more complications and death.
In PWH, barriers such as mental illness, drug abuse, homelessness, alcohol consumption have increased the risk of COVID-19 infection and negatively impacted access to healthcare. Further, before the widespread use of COVID-19 vaccination, PWH were two times at risk for severe acute respiratory syndrome 2 (SARS-CoV-2) infection than those without HIV.
Although several studies have tried to demonstrate the effects of HIV on COVID-19, they lacked appropriate control for potential collider bias.
The study
The present retrospective study was conducted at the University of California San Diego (UCSD) Health in those 18 years or older and receiving primary care service between March 1, 2020, and November 30, 2020.
All adults who tested SARS-CoV-2-positive were included in the study. Those who received treatment for any COVID-19-related illness from facilities outside UCSD were excluded to eliminate system differences in management practices.
Based on four hierarchical outcomes: SARS-CoV-2 diagnosis, COVID-19-associated hospitalization, intensive care unit (ICU) admission, and in-hospital death, the impact of HIV on COVID-19 outcomes was determined.
The HIV status impact on SARS-CoV-2 infection was analyzed using inverse probability weighted (IPW) analysis based on covariate distributions for testing bias (testing IPWs), HIV infection status (HIV IPWs), traditional covariate-adjusted, and combined models.
The researchers also determined whether the HIV plasma viral load (pVL) and CD4 count predicted the risk of COVID-19 outcomes among the PWH, using receiver operating characteristic (ROC) analysis.
Results
The results indicated that out of the 63,319 patients receiving primary healthcare services from UCSD Health, there were 4,017 PWH during the study period.
Individuals who were elderly, obese, White, and drug users; those with significant comorbidities, mental illness, and HIV infection; and homeless individuals were more likely to be tested for SARS-CoV-2 than those who did not fall into these categories
SARS-CoV-2-positive PWH were most commonly male, obese, young, non-White, homeless, smokers, drug abusers, and diagnosed with hypertension, diabetes mellitus, myocardial infarction, chronic pulmonary disease, mental illness, and liver disease compared to the SARS-CoV-positive people without HIV.
In the study period, out of the 487 SARS-CoV-2-positive patients, 88 were PWH and 399 were people without HIV. Among the SARS-CoV-2-positive PWH, six patients were admitted to the hospital for COVID-19-related complications, four were in the ICU, and one died at the hospital. Among the SARS-CoV-2-positive people without HIV, 57 patients were hospitalized, 19 were in the ICU, and seven died at the hospital.
The SARS-CoV-2 positivity rate was 2.1 times higher in PWH than people without HIV after considering comorbidity burden, potential testing bias, and HIV-IPW. These results were similar across all logistic regression models.
The median days of COVID-19 diagnosis to hospitalization was 5.5 for PWH and six days for people without HIV. Yet, the probability of COVID-19-associated hospitalization for the PWH was lower than those without HIV according to unadjusted and unweighted analysis, traditional covariate adjustment, and when HIV-IPWs are applied.
Similarly, the SARS-CoV-2-positive PWH did not show any difference in COVID-19-associated ICU admission and death from the COVID-19 patients without HIV after traditional covariate adjustment, unadjusted and unweighted analysis, HIV-IPWs, testing IPWs alone, and combined IPWs.
The median range of CD4 count was 638 and 634 for COVID-19-positive PWH and those without HIV infected with SARS-CoV-2, respectively. Further, the pVL was 88% and 85% for COVID-19-positive PWH and those without HIV, respectively. Among the PWH, neither CD4 count nor pVL predicted the risk of COVID-19-associated hospitalization with or without ICU admission and death, according to the ROC analysis.
Conclusions
The study findings were in line with previous studies reporting a similar incidence of COVID-19-associated ICU admission and mortality rate in PWH and those without HIV and in contrast to the studies reporting a higher COVID-19-associated hospitalization in PWH than those without HIV.
Overall, the study concluded that PWH had a higher rate of SARS-CoV-2-positivity than those without HIV. However, PWH had a similar or possibly lower COVID-19-related hospitalization and similar ICU admission and mortality rates compared to those infected with SARS-CoV-2 without HIV after controlling comorbidities and testing bias. Further, among SARS-CoV-2-positive PWH, neither pVL nor CD4 count predicted the risk of any of the study outcomes.
*Important notice
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
