Poor COVID-19 outcomes nearly 30% more likely in patients with HIV

Patients with HIV infection are at increased risk for poor COVID-19-related outcomes, especially those with low CD4+ counts and underlying conditions. These study results were published in The Journal of Infectious Diseases.

Researchers conducted a retrospective cohort study to assess the risk for poor COVID-19-related outcomes by HIV status among patients in New York City, New York. Data were sourced from New York City Department of Health and Mental Hygiene’s HIV surveillance registry and COVID-19 surveillance system between February and October of 2020. The primary outcomes were hospitalization 14 days before or after COVID-19 diagnosis and mortality within 60 days of COVID-19 diagnosis. Cox proportional hazards regression models were used to determine the association between HIV status and COVID-19-related hospitalization and mortality. Covariates included age at COVID-19 diagnosis, sex at birth, and the presence of at least 1 underlying condition.

A total of 248,678 COVID-19 diagnoses were included in the analysis, representing 2854 patients with and 245,824 without HIV infection. Patients with vs without HIV infection were more likely to be aged between 45 and 64 years, men (72% vs 51%), and Black or Hispanic (37% vs 15%). Patients with HIV infection also were more likely to have cancer (10% vs 4%), diabetes (26% vs 17%), and liver disease (24% vs 3%).

Mortality occurred among 341 (incidence rate [IR], 2.19 per 1000 person-days) patients with HIV infection and 18,426 (IR, 1.33 per 1000 patient-days) patients without HIV infection (crude incidence rate ratio [IRR], 1.65). Further comparisons by HIV status showed that the incidence of COVID-19-related mortality among HIV-positive patients was highest among women (IRR, 2.23), those aged between 18 and 44 years at COVID-19 diagnosis (IRR, 3.88), and Staten Island residents (IRR, 2.56).

In the adjusted analysis, the risk for COVID-related hospitalization was approximately 30% higher among patients with vs without HIV infection (adjusted hazard ratio [aHR], 1.28; 95% CI, 1.2-1.36). The risk for COVID-19-related mortality was also approximately 30% higher among HIV-positive patients (aHR, 1.27; 95% CI, 1.14-1.41).

Of HIV-positive patients, both the risk for COVID-19-related mortality (aHR, 2.38; 95% CI, 1.79-3.17) and hospitalization (aHR, 2.21; 95% CI, 1.87-2.60) was more than twice as high among those with lower CD4+ counts (<200 cells/µL vs ≥500 cells/µL).

Limitations of this study include potentially insufficient data on demographics and underlying conditions, and the exclusion of patients without laboratory-confirmed COVID-19 infection.

According to the researchers “[P]ositive HIV status may play a unique role in driving risk for adverse COVID-19 outcomes among women, perhaps related to social and structural determinants of health including gender discrimination and sexism.”

By Janelle Barowski, MSN RN

References:

Braunstein SL, Wahnich A, Lazar R. COVID-19 outcomes among people with HIV and COVID-19 in New York City. J Infect Dis. Published online August 3, 2023. doi:10.1093/infdis/jiad311