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

  1. Anna Maria Geretti
  2. Alexander J Stockdale
  3. Sophie H Kelly
  4. Muge Cevik
  5. Simon Collins
  6. Laura Waters
  7. Giovanni Villa
  8. Annemarie Docherty
  9. Ewen M Harrison
  10. Lance Turtle
  11. Peter J M Openshaw
  12. J Kenneth Baillie
  13. Caroline A Sabin
  14. Malcolm G Semple

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Abstract

Background

Evidence 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.

Methods

We 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).

Results

Among 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).

Conclusions

HIV-positive status was associated with an increased risk of day-28 mortality among patients hospitalized for COVID-19.

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  1. Version published to 10.1093/cid/ciaa1605
  2. ScreenIT

    SciScore for 10.1101/2020.08.07.20170449: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and limitations of this study: A key strength of our study is the ability to perform a direct comparison of people with and without HIV in the same dataset. Our analysis does not address risk factors for a COVID-19 diagnosis or a COVID-19 related hospitalisation among PWH, and cannot add to the current debate about the role of certain antiretroviral agents in modulating such risks.9,10 In addition, due to the format of data collection in ISARIC CCP-UK, our analysis cannot provide evidence of the role of HIV-related parameters on outcomes of COVID-19 related hospitalisation, as we did not have details of the ART history, current and nadir CD4 cell count, plasma HIV-1 RNA load, and history of previous HIV-related disease. Only a subset of CRFs from participants with HIV included a record of receiving ART and the records were frequently incomplete. Numerically, HIV-positive people who died were more likely not to have a record of being on ART than those who remained alive at day 28. However, it cannot be stated with certainty that those lacking an ART record were untreated nor therefore that lack of ART played a role in the adverse outcomes. Our experience of working with large HIV datasets is that we often find that people with missing data have worse mortality outcomes, simply because mortality prevents collection of a detailed treatment history. In the UK, 93% of the 103,000 people estimated to have HIV infection have been diagnosed and of these the vast majority (9...

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    ISRCTN66726260NANA

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.08.07.20170449v1 on medRxiv