People with HIV have a higher risk of COVID‐19 diagnosis but similar outcomes to the general population

  1. Michael E. Tang
  2. Thaidra Gaufin
  3. Ryan Anson
  4. Wenhong Zhu
  5. William C. Mathews
  6. Edward R. Cachay

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Abstract

Background

We investigated the effect of HIV on COVID‐19 outcomes with attention to selection bias due to differential testing and comorbidity burden.

Methods

This was a retrospective cohort analysis using four hierarchical outcomes: positive SARS‐CoV‐2 test, COVID‐19 hospitalization, intensive care unit (ICU) admission and hospital mortality. The effect of HIV status was assessed using traditional covariate‐adjusted, inverse probability‐weighted (IPW) analysis based on covariate distributions for testing bias (testing IPWs), HIV infection status (HIV‐IPWs) and combined models. Among people living with HIV (PWH), we evaluated whether CD4 count and HIV plasma viral load (pVL) discriminated between those who did and those who did not develop study outcomes using receiver operating characteristic analysis.

Results

Between March and November 2020, 63 319 people were receiving primary care services at the University of California San Diego (UCSD), of whom 4017 were PWH. The PWH had 2.1 times the odds of a positive SARS‐CoV‐2 test compared with those without HIV after weighting for potential testing bias, comorbidity burden and HIV‐IPW [95% confidence interval (CI): 1.6–2.8]. Relative to people without HIV, PWH did not have an increased rate of COVID‐19 hospitalization after controlling for comorbidities and testing bias [adjusted incidence rate ratio (aIRR) = 0.5, 95% CI: 0.1–1.4]. PWH did not have a different rate of ICU admission (aIRR = 1.08, 95% CI: 0.31–3.80) or of in‐hospital death (aIRR = 0.92, 95% CI: 0.08–10.94) in any examined model. Neither CD4 count nor pVL predicted any of the hierarchical outcomes among PWH.

Conclusions

People living with HIV have a higher risk of COVID‐19 diagnosis than those without HIV but the outcomes are similar in both groups.

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  1. Version published to 10.1111/hiv.13312
  2. ScreenIT

    SciScore for 10.1101/2022.01.13.22269178: (What is this?)

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

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Data were stored in REDCap (Research Electronic Data Capture, Vanderbilt University, Nashville, TN).
    REDCap
    suggested: (REDCap, RRID:SCR_003445)

    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 study is subject to limitations. First, like all observational SARS-CoV-2 studies, we could not implement routine universal SARS-CoV-2 screening to identify all patients with SARS-CoV-2 infection. This limitation is problematic especially for prognostic analyses, because of uncertainty regarding the proportion of included patients being asymptomatic at diagnosis and their COVID-related symptom burden at the time of diagnosis. The observation that median days to hospitalization after estimated date of infection did not differ significantly by HIV status provides some support that trajectories of disease progression were similar for both groups. Second, to reduce bias in our analyses due to missing records, varying standards of care, and referral indication, individuals were excluded if part of the COVID-19 care cascade occurred outside of UCSD Health. The number of excluded patients is unlikely to alter the conclusions based on included patients. Third, conclusions regarding the effect of HIV infection on ICU admission and hospital mortality should be interpreted cautiously because of the small number of ICU and mortality events in the study sample. Fourth, our PWH cohort generally had well-controlled HIV infection, with only 7% of those tested having AIDS and 9% a pVL above 200 copies/mL (Supplementary Table 4). Hence, our findings cannot be generalized to PWH populations with higher proportions of unsuppressed viremia. Similarly, we did not assess nadir CD4 counts, which...

    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

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  3. Version published to 10.1101/2022.01.13.22269178v1 on medRxiv