Association of HIV infection with outcomes among adults hospitalized with COVID-19

  1. Matthew S. Durstenfeld
  2. Kaiwen Sun
  3. Yifei Ma
  4. Fatima Rodriguez
  5. Eric A. Secemsky
  6. Rushi V. Parikh
  7. Priscilla Y. Hsue

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Abstract

The aim of this study was to evaluate the association of HIV infection with outcomes among people hospitalized with COVID-19.

Design:

A prospectively planned analysis of the American Heart Association's COVID-19 Cardiovascular Disease Registry.

Setting:

One hundred and seven academic and community hospitals in the United States from March through December 2020

Participants:

Consecutive sample of 21 528 adults hospitalized with COVID-19 at participating hospitals

Main outcome and measure:

Primary outcome was predefined as in-hospital mortality. We used hierarchical mixed effects models to assess the association of HIV with in-hospital mortality accounting for patient demographics, comorbidities, and clustering by hospital. Secondary outcomes included major adverse cardiac events (MACE), severity of illness, and length of stay (LOS).

Results:

The registry included 220 people with HIV (PWH). PWH were younger and more likely to be male, Non-Hispanic Black, on Medicaid, and active tobacco users. Of the study population, 36 PWH (16.4%) died compared with 3290 (15.4%) without HIV [risk ratio 1.06; 95% confidence interval (95% CI) 0.79–1.43; P  = 0.71]. After adjustment for age, sex, race, and insurance, HIV was not associated with in-hospital mortality (aOR 1.12; 95% CI 0.76–1.64; P  = 0.58) with no change in effect after adding BMI and comorbidities (aOR 1.14; 95% CI 0.78–1.68; P  = 0.51). HIV was not associated with MACE (aOR 0.99; 95% CI 0.69–1.44, P  = 0.91), COVID severity (aOR 0.96; 95% CI 0.62–1.50; P  = 0.86), or LOS (aOR 1.03; 95% CI 0.76–1.66; P  = 0.21).

Conclusion:

In the largest study of PWH hospitalized with COVID-19 in the United States to date, we did not find significant associations between HIV and adverse outcomes including in-hospital mortality, MACE, or severity of illness.

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  1. Version published to 10.1097/qad.0000000000003129
  2. ScreenIT

    SciScore for 10.1101/2021.04.05.21254938: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: Records are uploaded by participating hospitals and a deidentified dataset is provided to investigators after review by a scientific review committee.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Data Source/Study Population: The Get With The Guidelines® programs are provided by the American Heart Association (AHA).
    American Heart Association
    suggested: (American Heart Association, RRID:SCR_007210)
    We also report components of MACE outcomes, mechanical ventilation, management in intensive care unit, and venous thromboembolism including deep venous thrombosis and pulmonary embolism.
    MACE
    suggested: (MACE, RRID:SCR_005520)
    The American Heart Association Precision Medicine Platform (https://precision.heart.org/) was used for data analysis using R version 3.6.0 and SAS version 3.8. IQVIA (Parsippany, New Jersey) serves as the data collection and coordination center.
    American Heart Association Precision Medicine Platform
    suggested: None

    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:
    Limitations: The strengths of our study are that this is a large study population with over 21,000 people hospitalized at 107 hospitals with rigorous clinical adjudication of outcomes and detailed clinical phenotyping. The registry did not contain details regarding HIV such as treatment with antiretroviral therapy, CD4 counts, or viral loads. Despite diversity in hospital type and geographic location, the subset of hospitals participating in the registry may not be representative of all hospitals in the United States. Therefore, we focused not a population-based analysis to estimate marginal effects of the average additional risk of HIV but rather the conditional effect: what additional risk might a person living with HIV face conditional upon being admitted to a participating hospital. While the absolute number of HIV-infected individuals with MACE and death was low, our study does represent the largest study of PLWH hospitalized with COVID-19 to date. As an observational study, it remains possible that there is unmeasured confounding; to address this concern, we performed a propensity score-matched analysis in which we achieved good matching, but the results of this analysis were compatible with our findings as well as a significant association. As data are entered by each individual site, it is possible that there are variations in interpretation of the case definitions. We also did not account for calendar week or the local burden of the pandemic at a given hospital site ...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    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 10.1101/2021.04.05.21254938v1 on medRxiv
  4. Version published to 10.1101/2021.04.05.21254938v2 on medRxiv