Factors Associated With Severity of COVID-19 Disease in a Multicenter Cohort of People With HIV in the United States, March–December 2020

  1. Adrienne E. Shapiro
  2. Rachel A. Bender Ignacio
  3. Bridget M. Whitney
  4. Joseph A. Delaney
  5. Robin M. Nance
  6. Laura Bamford
  7. Darcy Wooten
  8. Jeanne C. Keruly
  9. Greer Burkholder
  10. Sonia Napravnik
  11. Kenneth H. Mayer
  12. Allison R. Webel
  13. H. Nina Kim
  14. Stephen E. Van Rompaey
  15. Katerina Christopoulos
  16. Jeffrey Jacobson
  17. Maile Karris
  18. Davey Smith
  19. Mallory O. Johnson
  20. Amanda Willig
  21. Joseph J. Eron
  22. Peter Hunt
  23. Richard D. Moore
  24. Michael S. Saag
  25. W. Christopher Mathews
  26. Heidi M. Crane
  27. Edward R. Cachay
  28. Mari M. Kitahata
  29. for the CFAR Network of Integrated Clinical Systems

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Abstract

Understanding the spectrum of COVID-19 in people with HIV (PWH) is critical to provide clinical guidance and risk reduction strategies.

Setting:

Centers for AIDS Research Network of Integrated Clinic System, a US multisite clinical cohort of PWH in care.

Methods:

We identified COVID-19 cases and severity (hospitalization, intensive care, and death) in a large, diverse HIV cohort during March 1, 2020–December 31, 2020. We determined predictors and relative risks of hospitalization among PWH with COVID-19, adjusted for disease risk scores.

Results:

Of 16,056 PWH in care, 649 were diagnosed with COVID-19 between March and December 2020. Case fatality was 2%; 106 (16.3%) were hospitalized, and 12 died. PWH with current CD4 count <350 cells/mm 3 [aRR 2.68; 95% confidence interval (CI): 1.93 to 3.71; P < 0.001] or lowest recorded CD4 count <200 cells/mm 3 (aRR 1.67; 95% CI: 1.18 to 2.36; P < 0.005) had greater risks of hospitalization. HIV viral load and antiretroviral therapy status were not associated with hospitalization, although most of the PWH were suppressed (86%). Black PWH were 51% more likely to be hospitalized with COVID-19 compared with other racial/ethnic groups (aRR 1.51; 95% CI: 1.04 to 2.19; P = 0.03). Chronic kidney disease, chronic obstructive pulmonary disease, diabetes, hypertension, obesity, and increased cardiovascular and hepatic fibrosis risk scores were associated with higher hospitalization risk. PWH who were older, not on antiretroviral therapy, and with current CD4 count <350 cells/mm 3 , diabetes, and chronic kidney disease were overrepresented among PWH who required intubation or died.

Conclusions:

PWH with CD4 count <350 cells/mm 3 , and a history of CD4 count <200 cells/mm 3 , have a clear excess risk of severe COVID-19, accounting for comorbidities associated with severe outcomes. PWH with these risk factors should be prioritized for COVID-19 vaccination and early treatment and monitored closely for worsening illness.

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  1. Version published to 10.1097/qai.0000000000002989
  2. ScreenIT

    SciScore for 10.1101/2021.10.15.21265063: (What is this?)

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

    Table 1: Rigor

    EthicsIRB: CNICS research has been approved by the institutional review boards at each site.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All analyses were conducted in Stata version 17 (StataCorp, College Station, TX).
    StataCorp
    suggested: (Stata, RRID:SCR_012763)
    NIAID)
    NIAID
    suggested: (NIAID, RRID:SCR_016598)

    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:
    Our analysis has some limitations. The number of COVID-19 cases identified likely underestimates the true prevalence of SARS-CoV-2 infection and COVID-19 disease. Thus, the proportion of cases who were hospitalized may be an overestimate, though absolute ascertainment of hospitalization and severe outcomes would not be affected. We were unable to make comparisons to the general population; such comparisons have been published, albeit without the rigorous case characterization and clinician hospitalization review as in CNICS.

    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.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.10.15.21265063v1 on medRxiv